1. Miniaturized hemodynamic transesophageal echocardiogram (hTEE) can accurately diagnose pericardial tamponade after open-heart surgery
Shreya Gupta, BS
Joseph Miessau, MS; Harrison Pitcher, MD; Qiong Yang, MD; Nicholas Cavarocchi, MD; Hitoshi Hirose, MD.
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.

2. Introduction
Cardiac tamponade in early priod of post cardiac surgery is a difficult and critical diagnosis
Hemodynamic Transesophageal Echocardiography (hTEE) is a point of care device
Emergent assessment and intervention is necessary to decrease mortality and morbidity
Negative exploration is not benign and may have worse outcomes

3. What is hTEE? Hemodynamic Trans-Esophageal Echocardiography
Miniaturized TEE probe
Non-invasive (5mm)
Real time monitoring
Keep in place max 72h
Allows visualization of cardiac function
Provides information on fluid status, ventricular function
This is a minitaurized TEE probe almost the size of an NG tube. It is non invasive real time monitoring providing us hemodynamic information, functioning of the Left and right ventricles.

4. Objective/ Methods
We investigated retrospectively whether hTEE could give information to diagnose post cardiotomy tamponade
Study period: May 2011 to July 2013
Total number of hTEE studies to r/o tamponade: 21 patients
17 males, 4 females
Average age of 60.7 years
We did a retrospective review of hTEE studies done on patients to rule out pericardial tamponade in early post-op period- 72h. The study period was from May to july The primary procedure on these patients were CABG +- valve, transplant, VAD and dissections. 21 patients underwent hTEE study with the clinical suspicion of post-cardiotomy tamponade.

5. Clinical suspicion of tamponade (n=21)
Negative
study
n=9
Small
hematoma
n=2
Positive study
n=10
Chest tube
n=1
Emergent OR
n=8
Coagulopathy
n=1
hTEE
observation
hTEE
observation
hTEE
observation
Stable size
Improved
effusion
Worsen
clot
For 18 unexplained hemodynamic instability followed by hTEE study, and 3 had unexplainable High CT draniage followed by hTEE studies to rule out tamponade. All of these patients were in cardiogenic shock [on four inotropes and or pressors with an average CI of 2. and CT output of avg 100ml/h- PA diastolic of and CVP of 12-13]
8 went for immediate OR explorations – which were all positive with 100% survival rate. One of patient had an tamponade that was managed by milking the CT- confirmatory hTEE showed marked hemodynamic improvement. Another patient, had extensive coagulopathy that was first managed medically and subsequently taken to the OR for a positive exploration.
2 patients had small hematomas without ventricular compression and repeated hTEE study showed no increase in size and hence OR exploration.
9 patients had a negative hTEE studies. None of these patients were taken to the OR for any explorations. These were dx with hypovolemia (5), RV failure (2) and BiV failure (2).
OR exp
OR finding of
tamponade: all
No OR
explorations
No OR
explorations
No OR
explorations

6. Conclusions
Miniaturized hTEE is an efficient tool that can diagnose early post-cardiotomy pericardial tamponade
May be able to reduce resources – both time and finance- by using hTEE in the intensive unit setting
Our retrospective study showed that hTEE is an efficient tool that can allow us to diagnose early pericardial tamponade in post-cardiotomy patients in timely fashion in conjunction with conventional monitoring. With hTEE, which is available in the intensive care unit and performed by intensivitists, we may reduce resource utilization.