Transesophageal Echocardiographic Examination of Left Subclavian Artery Branches

Ultrasound assessment of carotid arteries: Current concepts, methodologies, diagnostic criteria, and technological advancements

Following cardiac disease and cancer, stroke continues to be the third leading cause of death and disability due to chronic disease in the developed world. Appropriate screening tools are integral to early detection and prevention of major cardiovascular events. In a carotid artery, the presence of increased intima-media thickness, plaque, or stenosis is associated with increased risk of a transient ischemic attack or a stroke. Carotid artery ultrasound remains a long-standing and reliable tool in the current armamentarium of diagnostic modalities used to assess vascular morbidity at an early stage. The procedure has, over the last two decades, undergone considerable upgrades in technology, approach, and utility. This review examines in detail the current state and usage of this integrally important means of extracranial cerebrovascular assessment.

Transesophageal echocardiography estimation of coronary sinus blood flow for the adequacy of revascularization in patients undergoing off-pump coronary artery bypass graft

Aims and Objectives:

Physiologically coronary sinus (CS) drains the left coronary artery (LCA) territory. Stenosis of the branches of LCA may decrease the coronary sinus blood flow (CSBF). Any intervention that aims at restoring the flow of the stenosed vessel increases coronary artery flow that should consequently increase the CSBF. Hence, this study was undertaken to assess the CSBF before and after each branch of LCA to determine the adequacy of surgical revascularization in patients undergoing elective off pump coronary artery bypass grafting (OPCAB) using transesophageal echocardiography (TEE).

Materials and Methods:

Thirty consecutive patients scheduled for elective OPCAB were enrolled. CSBF was assessed before and after each branch of LCA revascularization using TEE. Left internal mammary artery (LIMA) Doppler was also obtained post LIMA to left anterior descending (LAD) grafting.

Results:

Hemodynamic and echocardiographic variables were compared by means of Student's t-test for paired data before and after revascularization. The CSBF per beat (1.28 ± 0.71), CSBF per minute (92.59 ± 59.32) and total velocity time integral (VTI) (8.93 ± 4.29) before LAD grafting showed statistically significant increase to CSBF per beat (1.70 ± 0.89), CSBF per minute (130.72 ± 74.22) and total VTI (11.96 ± 5.68) after LAD revascularization. The CSBF per beat (1.67 ± 1.03), CSBF per minute (131.91 ± 86.59) and total VTI (11.00 ± 5.53) before obtuse marginal (OM) grafting showed statistically significant increase to CSBF per beat (1.91 ± 1.03), CSBF per min (155.20 ± 88.70) and total VTI (12.09 ± 5.43) after OM revascularization. In 9 patients, color flow Doppler of LIMA could be demonstrated which showed diastolic predominant blood flow after LIMA to LAD grafting.

Conclusion:

Demonstration of CSBF was simple and monitoring the trend of CSBF values before and after each graft of LCA territory will guide to determine the adequacy of surgical revascularization.

Isolated Subclavian Artery Aneurysm: Evaluation by Transesophageal Echocardiography

A 50-year-old man was evaluated following a motor vehicle accident. Chest X-ray showed a widened mediastinum. Transesophageal echocardiography was helpful in identifying the left subclavian artery and in demonstrating an isolated subclavian artery aneurysm. The TEE findings correlated well with the results of chest CT. Using TEE for the identification of the aortic branches in patients with chest trauma may be critical.

Transesophageal Echocardiographic Identification of Normal and Stenosed Posterior Intercostal Arteries

We describe our experience in using transesophageal echocardiography to identify both right and left posterior intercostal arteries and assessing them for stenosis.

Transesophageal echocardiographic identification of bilateral vertebral artery ostial stenosis

We describe the usefulness of transesophageal echocardiography in correctly diagnosing severe ostial stenosis of both the left and right vertebral arteries in an adult patient. Although transesophageal echocardiography has been previously used to identify left vertebral artery stenosis, to our knowledge this study represents the first demonstration of its usefulness in detecting bilateral vertebral artery ostial stenosis.

Transesophageal echocardiographic evaluation of coronary arteries for stenosis in the elderly patient

This article documents the ability of transesophageal echocardiography to provide adequate images and clinically relevant information about the coronary anatomy of the elderly patient. Transesophageal echocardiography is commonly used to assess elderly patients who suffer cerebral vascular accidents. It is important to evaluate not only for the usually suspected causes of a cardiac source of emboli but also for direct and indirect evidence of coronary artery disease--the leading cause of death in the elderly stroke patient. Because atherosclerotic cardiovascular diseases identified in one vascular bed are prone to universally involve the other vascular territories to some degree, it is not surprising that the coronary arteries are often stenotic. As a sudden event with catastrophic symptoms, a stroke is commonly the first vascular event the elderly patient experiences. Depending on the degree of recovery, physical limitations may contribute to the lack of symptoms from coexistent peripheral or coronary artery disease. Transesophageal echocardiography may be the first, or only, coronary evaluation for high-risk elderly patients.

Transpharyngeal echocardiographic detection of a left internal carotid artery stent

This case report describes a patient in whom a left internal carotid (LIC) artery stent was detected using a transpharyngeal approach during a transesophageal echocardiographic (TEE) study. Using pulsed-Doppler interrogation, flow through and beyond the stent was characterized and restenosis was ruled out.

Transesophageal echocardiographic identification of left subclavian artery stenosis with steal phenomenon

In this report, we present the first case of the transesophageal echocardiographic identification of left subclavian artery stenosis and steal phenomenon.