van Zaane B, Nierich A P, Buhre W F, Brandon Bravo Bruinsma G J, Moons K G M
Department of (Thoracic) Anaesthesia and Intensive Care, Isala Clinics, The Netherlands.
Br J Anaesth. 2007 Apr;98(4):434-41. doi: 10.1093/bja/aem009. Epub 2007 Mar 2.
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.
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.
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).
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.
升主动脉（AA）动脉粥样硬化与心脏手术后的卒中有关。胸骨切开术前了解AA动脉粥样硬化的位置可改变手术策略，以避免对AA进行操作。评估AA动脉粥样硬化的金标准是术中主动脉外膜超声扫描（EUS）。经食管超声心动图（TOE）由于“盲区”无法检测到AA远端的动脉粥样硬化。一种使用充液导管的新方法[A-View（主动脉视图）方法]可能会增强对AA远端动脉粥样硬化的评估。本研究的目的是评估A-View方法是否真的能显示AA远端，并评估该技术的安全性。
在一项横断面诊断研究中，41例行心脏手术（包括胸骨切开术）的患者接受了相同的检查，包括TOE、A-View方法、EUS和常规手术监测。
使用A-View方法时，所有（100%）患者的AA远端均可见。使用A-View导管未出现临床重要的副作用；然而，有1例患者气管导管意外移位，导致血氧饱和度（SaO2）下降。与EUS结果相比，A-View方法显示的动脉粥样硬化严重程度在两种方法之间具有良好的一致性[kappa值为0.69（0.50 - 0.88）]。Bland-Altman分析显示斑块大小测量的一致性较差（偏差0.05 cm2，一致性界限为 - 0.63至0.74 cm2）。
A-View方法提供了一种微创且安全的方法，可在术前解决TOE的盲区问题。与EUS相比，A-View方法在检测AA动脉粥样硬化方面取得了令人满意的结果。A-View方法似乎是一种有前景的工具，可用于指导心脏手术患者的手术管理。
