title: Aortic arch branches are no longer a blind zone for transesophageal echocardiography: a new eye for aortic surgeons.
abstract: OBJECTIVE
  Branch arteries of the aortic arch have been a blind zone for transesophageal echocardiography. Information regarding blood flow, which is important in both planned and emergency operations on the aorta, has therefore been limited. We have established a technique for visualizing these arteries in nearly all cases.
  
  
  METHODS
  In 25 consecutive patients requiring either planned or emergency operations on the aorta, the branch arteries were visualized whenever cerebral malperfusion was suspected. Lateral flexion of the probe tip was used when the trachea interfered with visualization of the arteries.
  
  
  RESULTS
  The left subclavian, left and right common carotid, right subclavian, innominate, and left and right vertebral arteries were visualized in 96% (24/25), 92% (23/25), 96% (24/25), 100% (25/25), 84% (21/25), 92% (22/24), and 88% (21/24), respectively. The origin of the innominate artery was visualized in 36% (9/25). In some cases, dissection extended into branch arteries during surgery or during conservative therapy. When the subclavian artery was clamped, retrograde flow was detected in the vertebral artery (steal flow). The cannula for selective cerebral perfusion occasionally was entered into the right common carotid or subclavian artery and obstructed the other branch with a balloon.
  
  
  CONCLUSIONS
  The branch arteries of the aortic arch, including the vertebral artery, are no longer a blind zone for transesophageal echocardiography. The information obtained with our new transesophageal echocardiography technique is helpful for diagnosis, monitoring, and decision making during aortic surgery and in critical care medicine. Visualizing these vessels is worth the effort.
authors.affiliation: First Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan. kaori@mcai.med.hiroshima-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Orihashi
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuura
authors.forename: T
authors.initials: T
authors.lastname: Sueda
authors.forename: M
authors.initials: M
authors.lastname: Watari
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: Y
authors.initials: Y
authors.lastname: Sugawara
authors.forename: O
authors.initials: O
authors.lastname: Ishii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D013348:Subclavian Artery / Q000000981:diagnostic imaging*; D014711:Vertebral Artery / Q000000981:diagnostic imaging*