title: Resolving the blind spot of transoesophageal echocardiography: a new diagnostic device for visualizing the ascending aorta in cardiac surgery.
abstract: 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.
authors.affiliation: Department of (Thoracic) Anaesthesia and Intensive Care, Isala Clinics, The Netherlands. b.van.zaane@isala.nl
authors.forename: B
authors.initials: B
authors.lastname: van Zaane
authors.forename: A P
authors.initials: AP
authors.lastname: Nierich
authors.forename: W F
authors.initials: WF
authors.lastname: Buhre
authors.forename: G J
authors.initials: GJ
authors.lastname: Brandon Bravo Bruinsma
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000517:prevention & control