Aortic arch branches are no longer a blind zone for transesophageal echocardiography: A new eye for aortic surgeons Kazumasa Orihashi, MD, Yuichiro Matsuura,

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Presentation transcript:

Aortic arch branches are no longer a blind zone for transesophageal echocardiography: A new eye for aortic surgeons Kazumasa Orihashi, MD, Yuichiro Matsuura, MD, Taijiro Sueda, MD, Masanobu Watari, MD, Kenji Okada, MD, Yuji Sugawara, MD, Osamu Ishii, MD The Journal of Thoracic and Cardiovascular Surgery Volume 120, Issue 3, Pages 466-472 (September 2000) DOI: 10.1067/mtc.2000.108289 Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Schematic illustrations demonstrating scanning planes and corresponding image orientation for visualizing arch branch arteries. The orientation is horizontally flipped from that of a CT scan, as an echographer's view point. The shaded area is the blind zone caused by the trachea. R, Right; L, left; SCA, subclavian artery; CCA, common carotid artery; VA, vertebral artery; IA, innominate artery; IV, innominate vein; T, trachea; V, vertebra; IJV, internal jugular vein; SG, Swan-Ganz thermodilution catheter The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 TEEs showing arch branches. A, Left subclavian artery (L-SCA) , which gives off left vertebral artery (L-VA) toward the right in the longitudinal scan (L). B, Innominate artery (IA) adjacent to internal jugular vein (IJV) with Swan-Ganz thermodilution catheter (SG) inside in the transverse scan (T). C, Right common carotid artery (R-CCA) and adjacent internal jugular vein (IJV). D, Right subclavian artery (R-SCA), which gives off right vertebral artery (R-VA) toward the left. E, Origin of innominate artery (IA) in longitudinal scan. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Effect of lateral flexion of probe tip in visualizing innominate artery (IA) and left common carotid artery (L-CCA). Although these are in the blind zone, lateral flexion enables them to be visualized from the side of the trachea (T). L-SCA, Left subclavian artery. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 TEEs showing intraoperative extension of dissection into the right common carotid artery (R-CCA). A, Before operation, dissection is absent. B, During CPB, dissection extended into the right common carotid artery, making a true lumen (TL) compressed by a false lumen (FL). IJV, Internal jugular vein. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 TEEs showing converted flow direction in the left vertebral artery (L-VA) after unclamping and reperfusion of the left subclavian artery (L-SCA). Retrograde flow (positive) in the left vertebral artery turned to antegrade (negative) after unclamping. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 TEEs showing change of flow pattern in the left subclavian artery (L-SCA) after reconstruction. A, Before operation, dissection is present in the left subclavian artery with an intimal flap inside. B, Blood flow in the left subclavian artery. Flow is detected in both the true lumen (TL) and false lumen (FL). C, After reconstruction, flow is detected only in the true lumen. T, Trachea. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 466-472DOI: (10.1067/mtc.2000.108289) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions