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Ultrasound-Enhancing Agent Enables Transthoracic Echocardiography in Patients With Delayed Sternal Closure

  • Patrick Collins
    Affiliations
    Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
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  • Hazem Lashin
    Correspondence
    Address correspondence to Dr. Hazem Lashin, Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, EC1A 7BE, London, United Kingdom
    Affiliations
    Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, United Kingdom

    William Harvey Research Institute, Barts, and the London school of medicine and dentistry, Queen Mary University of London, Charterhouse square, London, United Kingdom
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Published:September 06, 2021DOI:https://doi.org/10.1053/j.jvca.2021.08.105
      DELAYED STERNAL CLOSURE (DSC) is a technique adopted to manage unstable patients after cardiac surgery, including low-cardiac-output state (LCOS), intractable bleeding, and arrhythmia.
      • Boeken U
      • Assmann A
      • Mehdiani A
      • et al.
      Open chest management after cardiac operations: Outcome and timing of delayed sternal closure.
      This cohort of patients may have extensive devices within the thorax, including metal retractors, vacuum- assisted closure systems, swabs, drains, and central venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulae, rendering cardiac visualization very challenging. Transesophageal echocardiography (TEE) is the main tool to assess cardiac function in these patients.
      • Fleck T
      • Kickinger B
      • Moidl R
      • et al.
      Management of open chest and delayed sternal closure with the vacuum assisted closure system: Preliminary experience.
      However, TEE is not without risk, and it may cause injury and bleeding in this often coagulopathic and anticoagulated DSC patient group.
      • Hilberath JN
      • Oakes DA
      • Shernan SK
      • et al.
      Safety of transesophageal echocardiography.
      These risks are multiplied in the DSC cohort due to the need for repeated examinations.

      Keywords

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