Transthoracic echocardiography in postoperative management of heart surgery.

Objective: In order to determine if routine use of transthoracic echocardio graphy (TTE) shortly after heart surgery could have a role in postoperative management, we carried out TTE in postoperative patients operated on for C ABG or valvular repair. Patients and methods: For a 3 months period, we prospectively enrolled 51 p atients for TTE. We performed a TTE using a Hewlett Packard Sonos 1500 and a 2.5 MHz probe. Feasibility, left ventricular kinesis, valve function, int racardiac thrombi, and pericardial effusion were noted for each patient. Pa tients have been divided into 2 groups : patients with or, without haemodyn amic disturbance (HD, mean arterial blood pressure less than or equal to 80 mmHg). Results: Nine TTE were impossible for bad acoustic images. Feasibility was about 82% (42 TTE/51 patients). Two ETT views were easily obtained: the api cal 4-chambers (75%) and the subcostal (30%) views. TTE examination induced treatment change in 12 patients for hypovolaemia (ten patients), left vent ricular dysfunction (one patient), and systolic anterior motion of mitral v alve (one patient). In patients without HD (41 patients) only hypovolaemia was found(three patients) and TTE returned to normal with fluid challenge. In patients with HD (ten patients), one patient returned to the operating r oom for valvular replacement, one patient was treated with dobutamine for l eft ventricular dysfunction, seven patients with hypovolaemia recovered wit h fluid challenge. Conclusion: TTE can guide postoperative management of patients operated on for heart surgery especially in patients with haemodynamic disturbance. Bec ause of its safety and easiness, TTE may be the first-line examination in t hese patients before any invasive evaluation. (C) 2001 Editions scientifiqu es et medicales Elsevier SAS.