Document Detail

Resolving the blind spot of transoesophageal echocardiography: a new diagnostic device for visualizing the ascending aorta in cardiac surgery.
MedLine Citation:
PMID:  17337475     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atherosclerosis of the ascending aorta (AA) and stroke after cardiac surgery are related. Knowledge of the location of AA-atherosclerosis pre-sternotomy allows changes in surgical strategy to avoid manipulation of the AA. The gold-standard for assessment of AA-atherosclerosis is intraoperative epiaortic ultrasound scanning (EUS). Transoesophageal echocardiography (TOE) is unable to detect atherosclerosis in the distal AA due to the 'blind spot'. A new method [A-View (Aortic-view) method] using a fluid-filled catheter may enhance the assessment of distal AA-atherosclerosis. The aim of this study was to evaluate whether the A-View method indeed visualizes the distal AA and to assess the safety of this technology. METHODS: In a cross-sectional diagnostic study, 41 patients undergoing cardiac surgery including sternotomy underwent the same work-up including TOE, the A-View method, EUS, and routine operative monitoring. RESULTS: With the A-View method, the distal AA was visible in all (100%) patients. There were no clinical important side-effects associated with the use of the A-View catheter; however, in one patient the endotracheal tube was accidentally dislocated leading to a decrease in Sa(O2). Severity of atherosclerosis visualized with the A-View method compared with EUS results showed good agreement between the two methods [Kappa of 0.69 (0.50-0.88)]. The Bland-Altman analysis showed poor agreement in plaque-size measurements (bias 0.05 cm2, limits of agreement - 0.63 to 0.74 cm2). CONCLUSIONS: The A-View method offers a minimally invasive and safe approach to preoperatively resolving the blind spot of TOE. Compared with EUS, the A-View method yielded satisfactory results in the detection of AA-atherosclerosis. The A-View method seems a promising tool for patients undergoing cardiac surgery to direct surgical management.
B van Zaane; A P Nierich; W F Buhre; G J Brandon Bravo Bruinsma; K G M Moons
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-03-02
Journal Detail:
Title:  British journal of anaesthesia     Volume:  98     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-16     Completed Date:  2007-05-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  434-41     Citation Subset:  IM    
Department of (Thoracic) Anaesthesia and Intensive Care, Isala Clinics, The Netherlands.
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MeSH Terms
Aged, 80 and over
Aortic Diseases / complications,  pathology,  ultrasonography*
Atherosclerosis / complications,  pathology,  ultrasonography*
Coronary Artery Bypass
Echocardiography, Transesophageal / adverse effects,  instrumentation*,  methods
Equipment Design
Intraoperative Care / instrumentation*,  methods
Middle Aged
Postoperative Complications / prevention & control
Sensitivity and Specificity
Stroke / etiology,  prevention & control

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