Substernal epicardial echocardiography: a recommended examination sequence and clinical evaluation in patients undergoing cardiac surgery.

Abstract

Substernal epicardial echocardiography is a novel echocardiography window, utilizing a modified mediastinal drain incorporating a sleeve for the insertion of a transesophageal echocardiography probe. Forty-six patients undergoing cardiac surgery from two institutions were evaluated, and an examination sequence was developed. An 11-view examination is presented as a consensus between the two institutions. In clinical usage, there were no major complications attributable to use of the device. Minor air leaks occurred in 6 patients, and 2 cases of sternal wound infection occurring in a cluster of infections are reported, but causation was not attributed to use of the device. There were no significant differences in measurements of the aortic valve area, pulmonary artery diameter, left ventricular outflow tract dimension, or the sinotubular junction between substernal and transesophageal examinations. All 16 wall-motion segments were well visualized in most patients with substernal epicardial echocardiography. Substernal epicardial echocardiography is a safe device for use in the postoperative environment.