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.
