Specific Considerations for the Protection of Patients and Echocardiography Service Providers When Performing Perioperative or Periprocedural Transesophageal Echocardiography during the 2019 Novel Coronavirus Outbreak: Council on Perioperative Echocardiography Supplement to the Statement of the American Society of Echocardiography Endorsed by the Society of Cardiovascular Anesthesiologists

Management of valvular and structural heart diseases during the coronavirus disease 2019 pandemic: an expert opinion of the Working Group on Valvular Heart Diseases, the Working Group on Cardiac Surgery, and the Association of Cardiovascular Interventions of the Polish Cardiac Society

“…Obtained imaging data should be recorded and not only focused on the main pathology but also they must be extensive enough to detect other significant, unexpected abnormal findings. 12,13 Personnel protection and prevention against virus transmission should be a priority during the COVID-19 pandemic.…”

Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

“…TEE carries an increased risk of transmission of SARS‐CoV‐2. While this risk is greater in nonintubated patients, viral transmission may still occur through direct contact with the patient's secretions, resulting in contaminated hands and surfaces with the potential to infect not just the echocardiographers but also other personnel in the OR 10 . Sternotomy requires a high‐speed device and is considered to be a procedure that leads to blood and tissue fluid aerosolization 4 .…”

“…Reducing the use of blower‐mister during OPCAB as far as practicable and depending on traditional measures for deairing after open cardiac surgery in preference to CO 2 insufflation would also be useful in reducing the aerosol load. Also, TEE should only be performed in intubated patients in the OR and only in those perioperative situations in which the benefits outweigh the risks 10 …”

“…Insertion of intrapleural chest drains at the start of the procedure and connecting them to the wall suction may reduce the aerosol generated from the electrocautery as well as from the blower‐mister in OPCAB surgery. There is some evidence that double gloving for tracheal intubation might provide extraprotection and minimize spread by fomite contamination of equipment and surroundings 10 . The use of fluid‐repellent long‐sleeved gown, eye protection, respirators.…”

Anesthesia for Cardiac Surgery during COVID-19 Pandemic

“…Transesophageal echocardiography (TEE) use carries heightened risk of viral aerosolization; hence, the following recommendations are given to reduce risk of transmission and cross-contamination. TEE use is indicated only if it is deemed necessary for the surgical procedure (benefits outweigh risks) such as mechanical complications of myocardial infarction, Stanford type A aortic dissection, valvular and perivalvular involvement in infective endocarditis, initiation of mechanical circulatory support, assessment of prosthetic valve, if the patient develops unexplained hemodynamic instability intraoperatively or if a procedural complication is suspected 14 (►Fig. 4).…”