The use of transesophageal echocardiography to guide sternal division for cardiac operations via mini-sternotomy.

Cardiac surgery utilizing the mini-sternotomy technique offers many advantages, including lessened pain and hospitalization. Mid-line upper sternotomy (or mini-sternotomy) can provide adequate exposure of the ascending aorta, the aortic root, the right atrial appendage and the dome of the left atrium. Inherent in providing adequate exposure is the level at which the sternum is "T'd" off. The lower aspect of the sternotomy is "T'd" off at the second, third, or fourth intercostal space depending on the patient's anatomy. We describe a technique that uses transesophageal echocardiography to determine the precise location for "T'ing" off the sternotomy, rather than approximating the sternotomy site by physical exam and chest radiograph. This technique will reliably delineate the sternotomy site, irrespective of a patient's body size and habitus.