Substernal epicardial echocardiography: A recommended examination sequence and clinical evaluation in patients undergoing cardiac surgery

Royse, Colin; Royse, Alistair; Bharatula, Ajay; Lai, James; Veltman, Michael; Cope, Louise; Kumar, Ajay

doi:10.1016/j.athoracsur.2004.02.093

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…In the healed infarct cohort, two weeks after myocardial infarction, baseline 2-D and 2-D-directed M-mode epicardial echocardiography (TTE) was performed in multiple views (standard short axis and long axis, as well as epicardial views)24 to assess LV ejection fraction and LV end diastolic dimension 25. Transthoracic echo was performed before implantation with the animal chest closed.…”

Section: Methodsmentioning

confidence: 99%

Autologous Cardiomyotissue Implantation Promotes Myocardial Regeneration, Decreases Infarct Size, and Improves Left Ventricular Function

et al. 2011

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Background-Cell therapy for myocardial infarction (MI) may be limited by poor cell survival and lack of transdifferentiation. We report a novel technique of implanting whole autologous myocardial tissue from preserved myocardial regions into infarcted regions. Methods and Results-Fourteen rats were used to optimize cardiomyotissue size with peritoneal wall implantation (300 m identified as optimal size). Thirty-nine pigs were used to investigate cardiomyotissue implantation in MI induced by left anterior descending balloon occlusion (10 animals died; male-to-female transplantation for tracking with in situ hybridization for Y chromosome, nϭ4 [2 donors and 2 MI animals]; acute MI implantation cohort at 1 hour, nϭ13; and healed MI implantation at 2 weeks, nϭ12 Key Words: myocardial infarction Ⅲ remodeling Ⅲ stem cells M yocardial infarction (MI) and its resultant left ventricular (LV) dysfunction remain a leading cause of mortality and morbidity. Different therapies for myocardial regeneration have been investigated with varying results and no definitive beneficial effects. [1][2][3][4][5][6][7][8][9][10][11] Concomitantly, the intrinsic regenerative potential of the myocardium has been increasingly recognized. [12][13][14] Adult cardiac stem cells injected into vasculature of rats after MI are able to differentiate into cardiomyocytes and arterioles. 15,16 In addition, it has been increasingly recognized that the delivery modality is a key limiting step in attempts at myocardial regeneration and angiogenesis with poor survival of transplanted cells (possible related to "milieu") and limited deposition and retention of injected cytokines. [17][18][19][20] This, coupled with mounting evidence relative to the lack of transdifferentiation potential of adult non-cardiac-derived stem cells, warrants a novel approach to myocardial regeneration. 21,22 Clinical Perspective on p 69We have developed a novel approach to adult cardiomyocyte transplantation. In a porcine model of MI, core biopsies of myocardial tissue are obtained from the preserved basal ventricular septum and used for implantation into the myocardial scar Received January 28, 2006; accepted October 8, 2010 MethodsAll experiments were performed in accordance with National Institutes of Health guidelines and were approved by the Institutional Animal Care and Use Committee at Beth Israel Deaconess Medical Center. Myotissue Sizing ExperimentsFourteen inbred rats (50 to 60 g) were used. Donor rats (nϭ3) were euthanized with CO 2 inhalation, and the heart was excised and placed in normal saline. Strips of varying diameters (100 to 500 mol/L) were obtained under a dissecting microscope. Eleven rats were then anesthetized with intraperitoneal ketamine/xylaxine (0.1 mL /100 g). The abdominal skin was incised and rectus muscle was exposed. Strips were implanted, and rectus fascia was closed with 10 -0 Prolene suture. Animals were divided into 5 groups (nϭ2 per group) with implantation of 100-, 200-, 300-, 400-, and 500-m strips (1 strip per animal). The animals were ...

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Section: Methodsmentioning

confidence: 99%

Autologous Cardiomyotissue Implantation Promotes Myocardial Regeneration, Decreases Infarct Size, and Improves Left Ventricular Function

et al. 2011

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“…Images obtained with SEE were compared with those obtained by TEE. Right ventricle and anterior structures were better visualized by SEE and the limitations of examination relate to posterior structures including the distal and descending aorta [77,81,82]. The examination can be repeated as frequently as needed in order to better monitor the response.…”

Section: Role Of Substernal Epicardial Echocardiography Imaging Technmentioning

confidence: 98%

“…The chief points to help in the diagnosis of diastolic heart failure in the postoperative heart are: (1) hemodynamic evidence of heart failure; (2) mean pulmonary capillary wedge pressure >12 mmHg [75]; (3) adequate cardiac index; (4) echocardiographic evidence of raised left atrial pressure (LAP) as evidenced by a distended LA with the interatrial septum displaying a fixed curvature towards the right atrium [76,77]; (5) echocardiographic evidence of a small LV in the absence of hypovolemia and valvular heart disease; (6) low EDV as determined by the pulmonary artery catheter; and (7) EF better or similar to the preoperative one (Table 2). Indeed according to the European criteria, a normal cardiac index in the face of pulmonary edema suggests diastolic heart failure [75].…”

Section: Diagnosis Of Diastolic Heart Failure In Postoperative Cardiamentioning

confidence: 99%

Recognition of diastolic heart failure in the postoperative heart

Alsaddique¹

2008

European Journal of Cardio-Thoracic Surgery

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Diastolic dysfunction is assuming more importance as it is increasingly evident that it can be solely responsible for heart failure. Although many comprehensive studies pertinent to diastolic dysfunction and diastolic heart failure have been recently published, there is a paucity of information on diastolic dysfunction appearing in the postoperative cardiac surgical patient. We sought to look into current literature searching for criteria that could be applied to help diagnose it in this group of patients in the intensive care setting where cardiac surgical patients are usually managed in the immediate postoperative period. Because of the almost similar clinical features it is important to make the distinction between diastolic or systolic heart failure.

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“…Assessment of the heart and lungs is performed based on the iHeartScan and iLungScan protocols designed and validated by the Ultrasound Education Group of the University of Melbourne [47][48][49]. Heart structure and function are assessed using two-dimensional (2D) images and color flow Doppler; spectral Doppler is not included in this study to facilitate timely completion of the ultrasound and to increase its reproducibility.…”

Section: Interventionmentioning

confidence: 99%

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

Cid

Canty

Royse

et al. 2020

Trials

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Background: Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design: A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion: This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.

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Substernal epicardial echocardiography: A recommended examination sequence and clinical evaluation in patients undergoing cardiac surgery

Cited by 10 publications

References 12 publications

Autologous Cardiomyotissue Implantation Promotes Myocardial Regeneration, Decreases Infarct Size, and Improves Left Ventricular Function

Autologous Cardiomyotissue Implantation Promotes Myocardial Regeneration, Decreases Infarct Size, and Improves Left Ventricular Function

Recognition of diastolic heart failure in the postoperative heart

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

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