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International Journal of Vascular Medicine
Volume 2017 (2017), Article ID 1857069, 8 pages
https://doi.org/10.1155/2017/1857069
Research Article

Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

1Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, Netherlands
2Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, Netherlands
3Department of (Thoracic) Anesthesia and Intensive Care, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, Netherlands
4Department of Cardiothoracic Surgery, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, Netherlands
5Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, Netherlands
6MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, Netherlands
7Department of Anesthesiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, Netherlands

Correspondence should be addressed to Wouter W. Jansen Klomp

Received 21 April 2017; Revised 27 June 2017; Accepted 18 July 2017; Published 11 September 2017

Academic Editor: Albert G. Hakaim

Copyright © 2017 Wouter W. Jansen Klomp et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Supplementary Material

Figure 1: Overview of TEE A-View technique. Schematic overview of the TEE A-View technique. By temporarily filling up the trachea with a saline filled balloon, the so called “blind spot” of conventional TEE is resolved. It enables a view of the upper mediastinum by physically looking through the trachea with ultrasound due to the lack of air in the trachea. After positioning of the A-View catheter in the trachea, the TEE probe is moved further into the esophagus in order to view the different images.

Figure 2: Clinical images of atherosclerosis with TEE A-View. (A) Upper Esophageal Distal Ascending Aorta Long Axis (LAX) A-View. On the posterior wall a mobile soft plaque is imaged, a high risk location if ECC is used in cardiac surgery or during Trans Aortic Valve Implantation procedures. (Image 2A). (B) Upper Esophageal Innominate Artery X-plane A-View. Direct through the trachea, the Innominate and left carotid artery are clearly visualized. This is of importance in case of atherosclerosis and aortic dissection. Direct flow from the aortic cannula into the innominate artery or left carotid artery during ECC might cause dislodgement of atherosclerotic debris with embolization into the brain. (Image 2B1 and Image 2B2). (C) Upper Esophageal Distal Ascending Aorta Color flow 3D and LAX A-View. Images of the so called “sand blasting” effect of CPB. These video’s show the impact of different flow directions and patterns of aortic cannulae on their potential impact on plaque dislodgement from the distal ascending aorta, arch and its side branches. Imaging will guide the surgical team to choose the best option. (Image 2C1, Image 2C2 and Image 2C3).

  1. Supplementary Material