Substernal epicardial echocardiography in a patient undergoing left ventricular assist device: a case report

A 59-year-old patient undergoing placement of a left ventricular assist device had a substernal epicardial echocardiography imaging technology device inserted intraoperatively. This was used postoperatively in the intensive care unit to optimise the patient's haemodynamic status and facilitate weaning from an intra-aortic balloon pump and inotropic support.

Substernal epicardial echocardiography (SEE) is a new echocardiography technique [1]. This is a modified chest drainage tube with a dual lumen creating an insertion pathway accommodating a trans-oesophageal echo (TOE) probe, while also acting as a mediastinal chest drain tube. The TOE probe lies within a blind-ended 'sock' along the underside of the chest drain. The device is placed in an anterior epicardial position prior to closure of the sternum, and allows the subsequent insertion of a standard TOE probe, allowing postoperative echocardiographic imaging of the heart. The chest tube sock permits rotational and vertical manipulation of the TOE probe.

We present the images obtained with the SEE and concur with a previous study that the quality of the images shown is excellent [2].

We conclude that this novel echo mode can be used serially in the intensive care unit to accurately assist in the assessment of ventricular function and filling during weaning of an intra-aortic balloon pump and inotropic drugs.