The Use of Handheld Ultrasound in Pre and Post Assessment of Patients Undergoing Heart Surgery in a Developing Country

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

It is widely known that the use of handheld ultrasound (US) is a vital tool in quickly assessing many pathologies associated with trauma, cardiac disease, fluid collection, abscesses, and more. In many places, especially developing countries, even simple echocardiograms or pre-surgical transesophageal echocardiograms aren't readily available. This is typically due to a lack of resources such as equipment, expertise in echocardiography, lack of infrastructure for billing, image storage, and electronic medical records. While on a medical mission trip, I explored the use of handheld US to answer important clinical questions to guide therapies in cardiac surgery patients.

Focused cardiac assessments were done in 24 studies on 9 patients aged 3 to 55 before and after cardiac surgery for coronary artery bypass, mitral valve replacement, aortic aneurysm repair, and congenital heart defects at Khwaja Yunus Ali University Medical School Hospital in Enaetpur, Bangladesh. Left ventricular (LV) function, presence of pericardial fluid, right ventricular (RV) function, ventricular volume assessment, aneurysm size, valve regurgitation/stenosis were amongst parameters assessed based on clinical circumstances. Multiple post-surgical assessments were performed based on clinical need and associated sequela over the course of 5 days with post-surgical patients convalescing in 2 large recovery rooms. These assessments were performed with an Echo Nous Kosmos US tablet with a phased array transducer and cardiac measurement package. Studies were typically done in under 3 minutes by an experienced cardiac sonographer in the presence of the surgical team during rounds.

In 3 patients who underwent septal defect repair (4-year-old male, 2-year-old male, 17-year-old female), RV function and volume status derived from echocardiographic images resulted in adding or weaning medications. In one patient with surgical repair of an aortic aneurysm and severe aortic valve regurgitation, quick bedside imaging led to post operative extubation. In one patient (55-year-old male) with coronary artery disease, pre-surgical imaging resulted in bypass grafting being postponed due to the finding of an LV apical aneurysm. In one post mitral valve replacement and left atrial clot evacuation (54-year-old male), LV function was assessed, and the patient was weaned from vasopressors. Finally, in one patient with post tetralogy of Fallot repair (4-year-old male), hemodynamic assessment of the right ventricular outflow tract led to the patient being weaned off a ventilator.

The use of portable handheld US as an extension of the cardiac physical examination proved to be vital in guiding and impacting therapies in seven of eleven patients where formal echocardiography resources were not previously available. In four of eleven patients, focused cardiac imaging confirmed that providers not adjust therapies by providing real-time functional and hemodynamic information.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1675

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