Initial clinical trial of substernal epicardial echocardiography: SEEing anew window to the postoperative heart

Background. Postoperative echocardiography windows are often of poor qualit y because of intervening air spaces around the heart and great vessels. We assessed the utility of a new commercially available adult chest drainage t ube that has been modified with the addition of a sterile sleeve to accommo date the introduction of a nonsterile pediatric transesophageal echocardiog raphy (TEE) probe. The TEE probe lies in a substernal epicardial position o n the postoperative heart allowing one to perform substernal epicardial ech ocardiography (SEE). Methods. Informed consent was obtained from 21 consecutive adult cardiac op eration patients. At the completion of the operation the SEE drainage tube was inserted through the rectus muscle and into the pericardium. After ches t closure, all patients underwent a full echo examination using an Acuson p ediatric biplane probe in the SEE position. Views obtained and ease of inse rtion were judged on a 1 to 10 (worst to best) scale. Results. Full SEE examinations were completed in an average of 12 minutes. Ease of probe entry and manipulation was excellent (ratings of 9.3 and 9.6, respectively). The quality of the anatomic images was also excellent. Subs ternal epicardial echocardiography tube positioning was integral to the ori entation of the images obtained. There were no complications related to the placement of the SEE tubes or TEE probes. In 4 of 21 patients (19%) the SE E methodology was used serially in the intensive care unit to accurately as sess ventricular function and filling during weaning of an intraaortic ball oon and inotropic agents. Conclusions. Substernal epicardial echocardiography is a safe and highly ef fective methodology for the serial echocardiographic assessment of the post operative heart. (C) 2001 by The Society of Thoracic Surgeons.