Fig. 5
Example of VExUS C grading system assessment in cardiac surgery. Patient #1: A 55-year-old woman undergoing tricuspid valve repair aortic valve replacement and mitral valve replacement known with chronic kidney disease (baseline eGFR = 35 mL/min/1.73 m2) with left ventricular ejection fraction of 40% and a high risk of major complications (EuroSCORE II = 16.8%) presented the following ultrasound findings at ICU admission after surgery: a Normal hepatic triphasic pattern, b a non-pulsatile portal flow and c continuous intral-renal venous flow and an IVC diameter of > 2.1 cm (not shown) corresponding to Grade 1 of VExUS C grading system. The patient did not develop acute kidney injury, was extubated 2.2 h after ICU admission and was discharged from the ICU less than 24 h after surgery. Patient #2: A 70-year-old man undergoing mitral valve repair with a left ventricular ejection fraction of 50% and a moderate risk of major complication (EuroSCORE II = 1.54%) presented the following ultrasound findings at ICU admission after surgery complicated by right ventricular dysfunction after cardiopulmonary bypass: d Systolic reversal of the hepatic venous flow, e severe portal flow pulsatility and f severe alteration in intra-renal venous flow corresponding to Grade 3 of the VExUS C grading system. The patient developed severe acute kidney injury and delirium in the post-operative period