Related Experiment Video
Updated: Aug 23, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Substernal epicardial echocardiography: a recommended examination sequence and clinical evaluation in patients
Colin F Royse1, Alistair G Royse, Ajay Bharatula
1Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Australia. colin.royse@mh.org.au
Background:
Substernal epicardial echocardiography is a novel echocardiography window, utilizing a modified mediastinal drain incorporating a sleeve for the insertion of a transesophageal echocardiography probe.
Methods:
Forty-six patients undergoing cardiac surgery from two institutions were evaluated, and an examination sequence was developed.
Results:
An 11-view examination is presented as a consensus between the two institutions. In clinical usage, there were no major complications attributable to use of the device. Minor air leaks occurred in 6 patients, and 2 cases of sternal wound infection occurring in a cluster of infections are reported, but causation was not attributed to use of the device. There were no significant differences in measurements of the aortic valve area, pulmonary artery diameter, left ventricular outflow tract dimension, or the sinotubular junction between substernal and transesophageal examinations. All 16 wall-motion segments were well visualized in most patients with substernal epicardial echocardiography.
Conclusions:
Substernal epicardial echocardiography is a safe device for use in the postoperative environment.
Related Concept Videos
Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
Acute Coronary Syndrome III: Diagnostic Studies
Cardiac Catheterization I: Pre-Procedure Overview
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
