Placing a Saline Bag Underneath the Heart Enhances Transgastric Transesophageal Echocardiographic Imaging During Cardiac Displacement for Off-Pump Coronary Artery Bypass Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 28; no. 1; pp. 42 - 48
• Main Authors: Sung, Tae-Yun, MD, Kwon, Mi-Young, MD, Muhammad, Hasimizy Bin, MD, Kim, Ju-Duck, MD, Kang, Woon-Seok, MD, Kim, Seong-Hyop, MD, PhD, Kim, Duk-Kyoung, MD, PhD, Yoon, Tae-Gyoon, MD, PhD, Kim, Tae-Yop, MD, PhD, Kim, Ji-Hyun, MD, Kang, Hyun, MD
• Format: Journal Article
• Language: English
• Published: United States 01-02-2014
• Subjects: Anesthesia & Perioperative Care; Coronary Artery Bypass, Off-Pump - methods; Critical Care; Echocardiography, Transesophageal - methods; Humans; Prospective Studies; cardiac surgery; transesophageal echocardiography; cardiac displacement; off-pump coronary artery bypass surgery; saline bag; stabilizers
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.04.011

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. Design Prospective observational study. Setting Tertiary University Hospital. Participants Adult patients undergoing OPCAB surgery. Interventions Intraoperative TEE examination Measurement and Main 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 (T control ), after cardiac displacement (T displaced ), and after placing the saline bag underneath the displaced heart (T saline-bag ). There were more LV-readable segments in the 17-segment model using integrated ME and TG views(ME + TG views) at T saline-bag and T control (mean[95% confidence interval], 17[17–17] and 17[17–17]) than using ME+TG at T displaced (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 T saline-bag (vs. 16[14–16], P < 0.001), but not at T displaced (vs. 15[14–15]). Incidences of inadequate RWM monitoring (LV-readable segments<14/17 using ME + TG views) at T saline-bag and T control (all 0/13) were less frequent than at T displaced (3/13, all P = 0.038). There were more LV-readable segments in TG basal- and mid-short-axis views at T saline-bag (median [range], 6[5–6] and 5[5-6]) than at T displaced (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.