Aortic arch branches are no longer a blind zone for transesophageal echocardiography: a new eye for aortic surgeons.
Aortic arch branches are no longer a blind zone for transesophageal echocardiography: a new eye for aortic surgeons.
复制标题
主动脉弓分支不再是经食管超声心动图的盲区：主动脉外科医生的新眼睛。
DOI：
10.1067/mtc.2000.108289
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
O. Ishii
中科院分区：
文献类型：
--
作者：
K. Orihashi;Y. Matsuura;T. Sueda;M. Watari;K. Okada;Y. Sugawara;O. Ishii
目标
主动脉弓分支动脉一直是经食管超声心动图的盲区。因此，有关血流的信息有限，而血流在计划和紧急的主动脉手术中都很重要。我们已经建立了一种技术，在几乎所有的情况下，这些动脉的可视化。
方法
在连续25例需要对主动脉进行计划或紧急手术的患者中，每当怀疑脑灌注不良时，都可以看到分支动脉。当气管干扰动脉可视化时，使用探头尖端的侧向弯曲。
结果
左锁骨下动脉、左和右颈总动脉、右锁骨下动脉、无名动脉和左和右椎动脉的显示率分别为96%（24/25）、92%（23/25）、96%（24/25）、100%（25/25）、84%（21/25）、92%（22/24）和88%（21/24）。36%（9/25）的无名动脉起始处可见。在某些病例中，夹层在手术或保守治疗期间扩展到分支动脉。当锁骨下动脉被夹闭时，在椎动脉中检测到逆行血流（盗血）。选择性脑灌注插管偶尔进入右侧颈总动脉或锁骨下动脉，用球囊阻塞另一分支。
结论
主动脉弓的分支动脉，包括椎动脉，不再是经食管超声心动图的盲区。新的经食管超声心动图技术获得的信息有助于主动脉手术和重症监护医学中的诊断、监测和决策。可视化这些血管是值得努力的。
OBJECTIVES
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.