title: Placing a saline bag underneath the heart enhances transgastric transesophageal echocardiographic imaging during cardiac displacement for off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  The authors hypothesized that placing a saline bag (saline-filled surgical glove) underneath a displaced heart would improve ultrasound transmission for transgastric (TG) imaging and transesophageal echocardiography (TEE) to visualize left ventricular regional wall motion (LV-RWM) during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary University Hospital.
  
  
  METHODS
  Adult patients undergoing OPCAB surgery.
  
  
  METHODS
  Intraoperative TEE examination
  
  
  RESULTS
  For off-line analyses of LV-readable segments, mid-esophageal (ME, 4-chamber, 2-chamber, and long-axis) and TG (basal- and mid-short-axis) TEE views were recorded under 3 different intraoperative conditions in 13 cases of OPCAB surgery: Before cardiac displacement (Tcontrol), after cardiac displacement (Tdisplaced), and after placing the saline bag underneath the displaced heart (Tsaline-bag). There were more LV-readable segments in the 17-segment model using integrated ME and TG views(ME + TG views) at Tsaline-bag and Tcontrol (mean[95% confidence interval], 17[17-17] and 17[17-17]) than using ME+TG at Tdisplaced (15[15-16], P = 0.002 and P<0.001, respectively). Using ME + TG views provided more LV-readable segments in the 17-segment model than using ME views at Tsaline-bag (vs. 16[14-16], P < 0.001), but not at Tdisplaced (vs. 15[14-15]). Incidences of inadequate RWM monitoring (LV-readable segments<14/17 using ME + TG views) at Tsaline-bag and Tcontrol (all 0/13) were less frequent than at Tdisplaced (3/13, all P = 0.038). There were more LV-readable segments in TG basal- and mid-short-axis views at Tsaline-bag (median [range], 6[5-6] and 5[5-6]) than at Tdisplaced (0[0-2] and 0[0-1], all P < 0.05).
  
  
  CONCLUSIONS
  Placing a saline bag underneath the displaced heart enhances the ability of TEE to visualize global LV-RWM by improving TG TEE imaging during OPCAB surgery.
authors.affiliation: Konyang University Hospital, Konyang University College of Medicine, Daejeon.
authors.forename: Tae-Yun
authors.initials: TY
authors.lastname: Sung
authors.affiliation: National Medical Center, Seoul.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kwon
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul.
authors.forename: Hasimizy Bin
authors.initials: HB
authors.lastname: Muhammad
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul.
authors.forename: Ju-Duck
authors.initials: JD
authors.lastname: Kim
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul.
authors.forename: Woon-Seok
authors.initials: WS
authors.lastname: Kang
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul.
authors.forename: Seong-Hyop
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Duk-Kyoung
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul.
authors.forename: Tae-Gyoon
authors.initials: TG
authors.lastname: Yoon
authors.affiliation: Konkuk University Medical Center, Konkuk University School of Medicine, Seoul. Electronic address: pondkim@unitel.co.kr.
authors.forename: Tae-Yop
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Chung-Ang University Medical Center, Chung-Ang University School of Medicine, Seoul, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D011446:Prospective Studies
keywords: cardiac displacement; cardiac surgery; off-pump coronary artery bypass surgery; saline bag; stabilizers; transesophageal echocardiography