Lung ultrasound in adult and paediatric cardiac surgery: is it time for routine use?

Abstract

Respiratory complications are common causes of morbidity and the need of repeated X-ray examinations after cardiac surgery. Ultrasound of the chest, including the lung parenchyma, has been recently introduced as a new tool to detect many pulmonary abnormalities. Despite this, the use of lung ultrasound (LUS) in adult and congenital cardiac surgery remains limited. In particular, lung ultrasound has been mainly used in the evaluation of pleural effusion (PLE), but no consensus exists on methods to quantify the volume of the effusion. Usefulness of LUS for the assessment of diaphragmatic motion in children has also been highlighted, but no clear recommendation exists regarding its routine use. Accuracy of LUS in detecting pulmonary congestion after adult cardiac surgery has been demonstrated, whereas studies in children are still scarce, and data on pneumothorax and lung consolidations are limited in the paediatric population. There are methodological and practicality issues regarding diagnostic protocols (i.e. image views and their sequential order) and instrumentation (transducers and their setting) used in different studies. It also remains unclear which practitioner-the cardiologist, intensivist, pulmonologist or the radiologist, should perform the examination. Cost analysis pertaining to extensive clinical application of lung ultrasound in cardiac surgery has never been performed. Guidelines and recommendations are warranted for a systematic and extensive use of this technique in cardiac surgery at different ages, as it could serve as a useful, versatile tool that could potentially decrease time, radiation exposure and costs.

Cardiac 3D Printing and its Future Directions

“…(42) Detailed reviews of cardiac congenital 3D printed modeling have recently been published. (1, 37, 46) A patient-specific 3D printed model used for pre-procedural planning of a catheter-based ASD closure is shown in figure 6. In this instance, cone-beam CT images were acquired to assist in pre-procedural planning (supplemental Video 2).…”

Lung ultrasound: a new basic, easy, multifunction imaging diagnostic tool in children undergoing pediatric cardiac surgery

“…Every area may be further divided into the upper and lower half. Thus for a complete LUS examination (3,4), six different quadrants for each hemithorax should be scanned (anterior superior, anterior inferior, lateral superior, lateral inferior, posterior superior, posterior inferior).Pulmonary complications are common in pediatric patients after cardiac surgery, and LUS may allow for fast diagnosis at patient's bed (5-8), and monitoring lung disease progression and/or the response to medical therapy (i.e., diuretics) and physiotherapy (5)(6)(7)(8). Despite this, the use of LUS in pediatric cardiac surgery remains very limited (6).…”

“…Pulmonary complications are common in pediatric patients after cardiac surgery, and LUS may allow for fast diagnosis at patient's bed (5-8), and monitoring lung disease progression and/or the response to medical therapy (i.e., diuretics) and physiotherapy (5)(6)(7)(8). Despite this, the use of LUS in pediatric cardiac surgery remains very limited (6).…”

“…LUS may be employed for the diagnosis of many common lung complications occurring after cardiac surgery including atelectasis, effusion, lung congestion, pneumonia, pneumothorax and diaphragmatic motion anomalies (5)(6)(7)(8). In contrast to X-RAY, LUS may allow to differentiate among effusion and atelectasis that are very common sequelae of cardiac surgery which require different therapeutic approaches (5)(6)(7)(8)14). Our group (5) recently described a new potential application of chest ultrasound in the diagnosis of retrosternal clots after pediatric cardiac surgery, that are common cause of hemodynamic unbalance and often difficult to diagnosis with conventional echocardiography.…”

“…Large studies conducted in adults have shown how the routine use of LUS may drastically reduce (i.e., from 8.8% to 0.97%, P<0.0001) the risk of pneumothorax in thoracentesis (15). LUS may be used also to monitor the occurrence of pneumothorax after drainage removal, avoiding the repetition of chest X-RAY examinations (that is a routine practice in many Centers) (6,15). Utility of LUS has been proved also for tracheal tube verification in NICU (14).…”