DK2985_C000 1..28 - AlSharqia Echo Club

280 Transesophageal Echocardiography(A)(B)HEMATOMALAAoVTVRAPVRV(C)(D)HEMATOMALALVAoRV(E)(F)TLAORTIC HEMATOMAFLFigure 12.30 (A, B) Mid-esophageal short-axis view in a 66-year-old man operated on for an aortic hematoma localised in the ascendingaorta (Ao) behind the noncoronary cusp. (C, D) The hematoma is located in the posterior aspect of the aortic root as seen also in the midesophageallong-axis view. No aortic regurgitation was present. (E) The hematoma could be seen on the proximal Ao in the operating room.(F) A false lumen (FL) and a true lumen (TL) were seen upon opening of the Ao (AoV, aortic valve; LA, left atrium; LV, left ventricle;PV, pulmonic valve; RA, right atrium; RV, right ventricle; TV, tricuspid valve). (Photos E and F courtesy of Dr. Michel Pellerin.)IX.SURGICAL STRATEGY IN THEMANAGEMENT OF THEATHEROSCLEROTIC ASCENDING AORTAThere are many tools and techniques available to thesurgeon for evaluation, investigation and management ofthe atherosclerotic ascending Ao around the time ofcardiac surgery. The history and physical examinationshould be carefully performed to identify risks factors foratherosclerotic disease. These include age, diabetes, andperipheral vascular disease. These factors increase the incidenceof atherosclerotic involvement of the ascending Ao.Intraoperative transesophageal echocardiogram hasbecome standard care for cardiac surgical procedures.Echocardiography and an EAS probe should be availablein each cardiac operating room.The data collected from these studies must be properlyinterpreted and acted upon appropriately. Epiaortic scanningis becoming the gold standard for intraoperativeassessment of the ascending Ao. Based on the informationcollected, the surgical approach for individual patients isthen determined in response to objective findings of thepatient’s diagnosis, comorbid condition, epiaortic scan,and the nature of the surgery comtemplated. An algorithmon the evaluation and surgical management of the atheroscleroticascending Ao is shown (Fig. 12.32).