Intraoperative transoesophageal echocardiography as an adjuvant to fluoroscopy during endovascular thoracic aortic repair

Objectives: to define the utility of intraoperative transeophageal echocardiography (TEE) during endovascular thoracic aortic repair. Design: retrospective study. Materials: five patients underwent six transluminal endovascular stent-graft procedures for repair of thoracic aortic disease. Methods: after induction of anaesthesia, a multiplane or biplane TEE probe was placed to obtain views of the diseased aorta. Both transverse and longitudinal planes of the aortic arch and descending thoracic aortic segments were imaged. The aortic pathology was confirmed by TEE and the proximal and distal extents of the intrathoracic lesion were defined. Doppler and colour-flow imaging was used to identify flow patterns through the aorta before and after stent-graft deployment. Results: visualisation and confirmation of the aortic pathology by ultrasonography was accomplished in all patients. TEE was able to confirm proper placement of the endograft relative to the aortic lesion after deployment and was able to confirm exclusion of blood flow into the aneurysm sacs. Conclusions: TEE may facilitate repair by confirming aortic pathology, identifying endograft placement, assessment of the adequacy of aneurysm sack isolation, as well as dynamic intraoperative cardiac assessment.