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.
1
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.
2
However, TEE is not without risk, and it may cause injury and bleeding in this often
coagulopathic and anticoagulated DSC patient group.
3
These risks are multiplied in the DSC cohort due to the need for repeated examinations.Keywords
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References
- Open chest management after cardiac operations: Outcome and timing of delayed sternal closure.Eur J Cardiothorac Surg. 2011; 40: 1146-1150
- Management of open chest and delayed sternal closure with the vacuum assisted closure system: Preliminary experience.Interact Cardiovasc Thorac Surg. 2008; 7: 801-804
- Safety of transesophageal echocardiography.J Am Soc Echocardiogr. 2010; 23: 1115-1127
- Contrast echocardiography in critical care: Echoes of the future? A review of the role of microsphere contrast echocardiography.Crit Care Resusc. 2011; 13: 44-55
- Contrast-Enhanced echocardiography application in patients supported by extracorporeal membrane oxygenation (ECMO): A narrative review.J Cardiothorac Vasc Anesth. 2021; (S1053-0770(21)00357-8)
- Echocardiography of the aortic root.Invest Radiol. 1968; 3: 356-366
- Clinical practice of contrast echocardiography: Recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017.Eur Heart J Cardiovasc Imaging. 2017; 18 (1205-1205af)
- Mechanical index.Anatol J Cardiol. 2015; 15: 334-336
- Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography guidelines update.J Am Soc Echocardiogr. 2018; 31: 241-274
- The clinical impact of bedside contrast echocardiography in intensive care settings: A Korean multicenter study.Korean Circ J. 2015; 45: 486-491
- Contrast echocardiography clarifies uninterpretable wall motion in intensive care unit patients.J Am Coll Cardiol. 2000; 35: 485-490
- Contrast echocardiography improves the diagnostic yield of transthoracic studies performed in the intensive care setting by novice sonographers.J Am Soc Echocardiogr. 2005; 18: 475-480
- Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit.Am J Cardiol. 2002; 89: 711-718
- Perflutren-based echocardiographic contrast in patients with right-to-left intracardiac shunts.JACC Cardiovasc Imaging. 2014; 7: 206-207
- Myocardial mechanics: Understanding and applying three-dimensional speckle tracking echocardiography in clinical practice.Echocardiography. 2012; 29: 861-872
- Meta-analysis of adverse cardiovascular events associated with echocardiographic contrast agents.Am J Cardiol. 2010; 106: 742-747
- Safety of contrast agent use during stress echocardiography in patients with elevated right ventricular systolic pressure: A cohort study.Circ Cardiovasc Imaging. 2010; 3: 240-248
- The effect of Definity on systemic and pulmonary hemodynamics in patients.J Am Soc Echocardiogr. 2012; 25: 584-588
- Effect of Optison on pulmonary artery systolic pressure and pulmonary vascular resistance.Am J Cardiol. 2013; 112: 1657-1661
- Safety of transesophageal echocardiography.J Am Soc Echocardiogr. 2010; 23 (quiz 1220-1): 1115-1127
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Published online: September 06, 2021
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