title: A systematic approach to substernal epicardial echocardiographic examination.
abstract: OBJECTIVE
  The importance of echocardiography in the perioperative management of cardiac surgical patients is widely appreciated. A modified mediastinal drain has been developed, which allows the introduction of a standard TEE probe in a closed-ended sleeve coupled with the drain to permit epicardial echocardiographic imaging after chest closure (substernal epicardial echocardiography [SEE]). The aim of the present study was to develop a standardized and comprehensive SEE examination sequence to allow repeatable examinations with a single movement of the TEE probe inside the drain.
  
  
  METHODS
  Prospective observational protocol.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Ten adult patients undergoing elective cardiac surgery.
  
  
  METHODS
  Twenty-three SEE examinations in 10 patients undergoing elective myocardial revascularization to develop a standard examination sequence.
  
  
  RESULTS
  The examination sequence includes 11 views with all the structures relevant for postoperative monitoring. The entire sequence is performed with a single in-out movement of the transesophageal probe to minimize discomfort to patients and the risk of damaging the tube.
  
  
  CONCLUSIONS
  This new approach to the perioperative monitoring of cardiac surgical patients represents an option for patients in whom TEE is contraindicated or multiple examinations are anticipated because SEE examinations can be performed without the need for sedation in awake patients.
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. f.sangalli@hsgerardo.org
authors.forename: Fabio
authors.initials: F
authors.lastname: Sangalli
authors.forename: Francesco
authors.initials: F
authors.lastname: Formica
authors.forename: Bruna
authors.initials: B
authors.lastname: Manetti
authors.forename: Margherita
authors.initials: M
authors.lastname: Trabucchi
authors.forename: Leonello
authors.initials: L
authors.lastname: Avalli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paolini
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000000981:diagnostic imaging; D006348:Cardiac Surgical Procedures; D015505:Chest Tubes; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D010496:Pericardium / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D013249:Sternum / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging