title: A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination.
abstract: OBJECTIVE
  More than a decade before the introduction of intraoperative transesophageal echocardiography (TEE), epicardial echocardiography was already in use as a diagnostic imaging modality to assist cardiac surgeons and anesthesiologists with clinical decision making. Although TEE has since become increasingly more popular, epicardial echocardiography may be the most convenient intraoperative imaging technique when TEE probe placement cannot be performed or is contraindicated. The authors developed a comprehensive examination protocol for the intraoperative interrogation of cardiac structures using an epicardial/epiaortic echocardiographic approach.
  
  
  METHODS
  Retrospective analysis of patient's medical records.
  
  
  METHODS
  Single-center academic tertiary care hospital.
  
  
  METHODS
  Patients undergoing cardiac surgery.
  
  
  METHODS
  A total of 10 echocardiographic views were obtained for imaging cardiac structures, the ascending aorta, and proximal aortic arch. The described imaging planes permit the evaluation of ventricular performance, valvular function, cardiac structural abnormalities, and aortic disease.
  
  
  RESULTS
  A comprehensive epicardial/epiaortic echocardiographic examination was performed in 20 patients undergoing cardiac surgery requiring a full sternotomy. The described imaging planes were obtained in all patients in less than 8 minutes (range, 3.5-8 minutes; mean, 5.5 minutes).
  
  
  CONCLUSIONS
  The present manuscript delineates a protocol for performing a comprehensive, intraoperative epicardial/epiaortic echocardiographic examination. Echocardiographic imaging planes of cardiac and aortic anatomy are described. This protocol may be useful for cardiac surgeons and anesthesiologists seeking to use this technique as a cardiac imaging modality that is complementary to TEE.
authors.affiliation: Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Holger K
authors.initials: HK
authors.lastname: Eltzschig
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Kallmeyer
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Sailaja
authors.initials: S
authors.lastname: Alapati
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D004452:Echocardiography / Q000295:instrumentation; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D007430:Intraoperative Care; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors