Perioperative feasibility of imaging the heart and pleura in patients with aortic stenosis undergoing aortic valve replacement

Abstract

Highest possible flow rate, smaller sized syringes and syringe plungers with reduced compressibility should be preferred in order to avoid significant start-up delays in fluid delivery.

Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery

“…The most likely reasons for improvement in the image quality of transthoracic echocardiography include advances in ultrasound technology, such as harmonic imaging, and the increasing use of transthoracic echocardiography by intensive care physicians. Other limitations of transthoracic echocardiography include worse imaging soon after surgery [9,20] and difficulty using the subcostal window [33][34][35][36]. This is shown by three studies in our review that reported lower rates of interpretability on the first postoperative day compared with later [9,11,21] and may be due to the presence of dressings and drainage tubes, or patient discomfort.…”

“…An overview of the included full-text publications with primary and secondary outcome measures is shown in Table 1. There were seven studies reporting the use of transthoracic echocardiography [9,11,[18][19][20][21][22] and eight for transoesophageal echocardiography [23][24][25][26][27][28][29][30]. There were eight uncontrolled prospective observational studies [9, 11, 19, 21-23, 26, 28], and seven retrospective cohort studies [18,20,24,25,27], of which only two had a control group [29,30].…”

“…Jakobsen et al [9] reported that the apical and parasternal windows were superior to the subcostal window in terms of image quality, presumably due to surgical dressings and drainage tubes in the subcostal position. Flynn et al [20] demonstrated that inadequate assessment of left ventricular function with transthoracic echocardiography was associated with increasing age, male sex, mechanical ventilation of the lungs and the early postoperative period.…”

“…However, the increase in its use has been restricted due to lack of training and because it is an invasive procedure, usually requiring sedation and/ or mechanical ventilation of the patients lungs, and there is a small risk of oesophageal injury, which is a potentially lethal complication [8]. Although previously reported to be more difficult than transoesophageal echocardiography in the postoperative cardiac surgical patient, transthoracic echocardiography is non-invasive and improved image quality has recently been reported [9].…”

A systematic review of transthoracic and transesophageal echocardiography in non-cardiac surgery: implications for point-of-care ultrasound education in the operating room

“…Nevertheless, TEE does not interfere with most surgical procedures and provides superior imaging, particularly in the tracheally intubated patient. 23,24 There were some limitations in our review. For example, the studies in our analysis were completed by physicians with advanced level training in ultrasound, and all completed a comprehensive ultrasound examination.…”