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Eur J Cardiothorac Surg 2002;22:146
© 2002 Elsevier Science NL

Images in cardio-thoracic surgery

A simple method to control a malposition of inferior venous cannula in cardiac surgery using transesophageal echocardiography

Anesthesiology Service, Hospital Universitario de Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain

Received 29 January 2002; accepted 22 March 2002.

* Corresponding author
e-mail: med026221{at}saludalia.com

Key Words: Cardiac surgery • Venous cannulation • Transesophageal echocardiography

Transesophageal echocardiography in cardiac surgery can be a useful technique in detection of unrecognized problems caused by aortic or venous cannulas. Malposition of a venous cannula can reduce blood flow draining into the pump and cause a perfusion problem. We propose a very simple method to control the position of a venous cannula in the inferior vena cava and rule out a malposition in the hepatic veins (Fig. 1) . We use a multiplane transesophageal probe and introduce it into the transgastric short axis (by advancement of the probe to the stomach and gentle anteflexion of the tip). In this position we can view a cross-section image of both ventricles; then, the probe is rotated clockwise to place the liver in the center of the field. Finally, we adjust the axis of interrogation between 0 and 60° to obtain a liver view with the inferior vena cava on the back face and the hepatic vein draining into the cava (Fig. 2) . This simple maneuver permits us to anticipate a probable perfusion problem during the cardiopulmonary bypass.

View larger version (57K): [in this window] [in a new window]   Fig. 1. Transesophageal echocardiogram showing a malposition of venous cannula into the hepatic vein. 1, Liver; 2, vena cava; 3, hepatic vein; 4, venous cannula into the hepatic vein.

View larger version (31K): [in this window] [in a new window]   Fig. 2. Transesophageal echocardiogram showing a well-positioned venous cannula into the vena cava. 1, liver; 2, vena cava; 3, hepatic vein; 4, venous cannula in vena cava.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sastre Rincón, J.A. Articles by Muriel Villoria, C. Search for Related Content PubMed PubMed Citation Articles by Sastre Rincón, J.A. Articles by Muriel Villoria, C. Related Collections Cardiac - physiology Cardiac - other