Emerging technologyVisualization of the Distal Ascending Aorta With A-Mode Transesophageal Echocardiography
Section snippets
The Clinical Application of the A-View Method
The patients described in this article all gave written informed consent to use their clinical data. The A-View method is approved for clinical use by both Conformité Européene (CE) marking and the United States Food and Drug Administration and thus may be used for diagnostic purposes in patients.
The A-View method uses a saline-filled balloon catheter to replace the air in the tracheobronchial tree during the investigation (Fig 2). This fluid creates an ultrasound-conducting window and the
A-View Distal Ascending Aorta View
From the conventional TEE midesophageal ascending aorta short-axis view, the A-View distal ascending aorta short-axis view is developed by retraction of the probe until a depth of approximately 25 to 30 cm from the incisors with the multiplane angle adjusted to 30°. Rotating the multiplane angle to between 70° and 120° will develop the midesophageal A-View ascending aorta long-axis view (Fig 4). The anterior and posterior walls of the distal ascending aorta appear parallel to one another. The
Case 1: Screening of the Distal Ascending Aorta for Atherosclerosis
A 71-year-old woman was scheduled for elective coronary artery bypass graft surgery. There were no preoperative risk factors besides hypertension. When using the A-View method, a moving mass on the posterior wall of the distal ascending aorta of 22-mm length and 5-mm thickeness, just opposite the location of the planned aortic cannulation in the anterior wall of the distal ascending aorta, was visible (Fig 4). The surgeon thus changed the initially planned site of cannulation to the aortic arch
Discussion
With the introduction of the A-View method, it is possible to image the distal ascending aorta and the proximal aortic arch before sternotomy. The A-View method offers a fast, easy, safe, and minimally invasive approach to resolving the blind spot of conventional TEE.5 Since the introduction of the A-View method, it has been used for the clinical indications as described.
Conclusion
The A-View method offers an approach to resolve the blind spot of TEE. The method already has been used for numerous indications (eg, assessment of ascending aorta atherosclerosis, monitoring cerebral blood, and diagnosing aortic dissection). The A-View method seems to be a promising tool for patients undergoing cardiac surgery or who are suffering from aortic disease to direct management and may eventually improve patient outcome.
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Cited by (13)
Atheromatous disease of the aorta and perioperative stroke
2018, Journal of Thoracic and Cardiovascular SurgeryFeasibility of Using Endobronchial Ultrasound for a Complete Examination of the Thoracic Aorta: A Case Report of Acute Traumatic Aortic Injury
2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The inability to perform a complete examination of the intrathoracic aorta using transesophageal echocardiography has been well described.4,5,7 Previous investigations have used different accessories to overcome this limitation, using a saline-filled catheter to replace the air in the bronchial tree.10,11 However, it was not clear how this method would affect ventilation in a trauma patient because it would occlude at least one main bronchus.
Diagnostic accuracy of modified transoesophageal echocardiography for pre-incision assessment of aortic atherosclerosis in cardiac surgery patients
2010, British Journal of AnaesthesiaCitation Excerpt :The A-View method uses an intratracheal balloon (the A-View catheter developed by Cordatec Inc. in Zoersel, Belgium) filled with saline to replace the air in the distal trachea and left main bronchus. It therefore becomes possible to assess the distal AA and aortic arch for the presence and severity of atherosclerosis before cardiac surgery, which provides the surgeon with 30–45 min of additional planning time.17 18 The question arises as to whether modified TOE (the A-View method) used before the sternotomy and the corresponding changes in the surgical strategy yield better patient outcomes compared with surgery using EUS.
Multimodality Imaging of Aortic Disease
2020, Current Treatment Options in Cardiovascular MedicineTransesophageal echocardiography evaluation of the aortic arch branches
2018, Annals of Cardiac AnaesthesiaA Protocol for Diagnosis and Management of Aortic Atherosclerosis in Cardiac Surgery Patients
2017, International Journal of Vascular Medicine
Gerard R. Manecke, Jr, MD
Marco Ranucci, MD
Section Editors
The development of the A-View Catheter was partly supported by a grant (grant no. 030494) from the Institute for the Promotion of Innovation by Science and Technology, Flanders, Belgium.
A.P.N. is medical director of Cordatec Inc, Zoersel, Belgium; A.P.N., B.v.Z., W.F.B., and K.G.M.M. have received a grant from the Dutch Government for studying the diagnostic accuracy of the A-View method.