Proefschrift Jansen Klomp

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The diagnosis of atherosclerosis of the distal ascending aorta in cardiac surgery patients EPIAORTIC ULTRASOUND (REFERENCE TEST) EUS (L15-7io epiaortic probe, Philips, Eindhoven, the Netherlands) served as the reference test. Short- and long-axis images of the proximal and DAA were obtained. 15 EUS was performed after sternotomy and opening of the pericardium, the surgeon performing and interpreting the EUS was unaware of the results of modified TEE. DATA COLLECTION During surgery, the attending anesthesiologist registered the highest degree of atherosclerosis visualized with TEE, modified TEE, and EUS on dedicated forms. For all three modalities, the degree of atherosclerosis was recorded in four segments of the thoracic aorta, i.e. the proximal and DAA, the aortic arch and descending aorta. Severity of atherosclerosis was determined according to the Katz’s classification (Figure 1), severe atherosclerosis was defined as grade 3 or greater. 16 The DAA was defined as the aorta distal from the crossing with the right pulmonary artery until the innominate artery. Patient characteristics and perioperative data were extracted from a prospective ongoing registry in which pre-, peri- and post-operative data from all patients undergoing cardiothoracic surgery in the Isala Clinics were collected. STATISTICAL ANALYSIS Baseline characteristics were described by mean (standard deviation) for normally distributed and median (interquartile range) for non-normally distributed variables; statistical differences were assessed using a Student’s t-test or Mann–Whitney U test, respectively. Nominal variables were presented as frequencies and percentages of total; statistical difference was tested using a c2 or Fisher’s exact test as appropriate. A contingency table was constructed to compare the diagnosis of severe atherosclerosis of the DAA with the index and reference test, respectively. From this table, we calculated sensitivity and specificity, the positive and negative predictive value (PPV and NPV, respectively) and positive and negative likelihood ratios of modified TEE. 35
Chapter 3 Figure 1. Distal, long-axis view of the DAA as imaged with modified TEE, showing, (A) Normal aorta, (B) extensive intimal thickening, (C) protruding atheroma,5 mm, (D) protruding atheroma >5 mm, (E) mobile plaque. (1, anterior wall; 2, posterior wall; 3, inflated A-View balloon (arrow indicates atheroma). 36
Page 1 and 2: diagnostic challenges in aortic dis
Page 3 and 4: DIAGNOSTIC CHALLENGES IN AORTIC DIS
Page 5 and 6: PROMOTIECOMMISSIE Promotor: prof. d
Page 8: 1 General introduction and outline
Page 11 and 12: Chapter 1 the exclusion than for th
Page 13 and 14: Chapter 1 REFERENCES 1. Markou ALP,
Page 16: PART ONE AORTIC ATHEROSCLEROSIS
Page 19 and 20: Chapter 2 ABSTRACT The most severe
Page 21 and 22: Chapter 2 IMAGING TECHNIQUES OF THE
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Page 34 and 35: The diagnosis of atherosclerosis of
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Page 77 and 78: Chapter 5 ABSTRACT OBJECTIVE Athero
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Chapter 5 STROKE The predicted inci
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Chapter 5 describe the indications
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Chapter 5 15. Jansen Klomp WW, Peel
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Chapter 6 ABSTRACT BACKGROUND Modif
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Chapter 6 INTRODUCTION Presence of
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Chapter 6 as a normal aorta or exte
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Chapter 6 of a different aortic can
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Chapter 6 meet the inclusion criter
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Chapter 6 Modified TEE was performe
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Chapter 6 CLINICAL ENDPOINTS AND QU
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Chapter 6 lead to effective changes
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Chapter 6 with a higher risk of aor
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Chapter 6 REFERENCES 1. van der Lin
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Chapter 6 32. Knipp SC, Matatko N,
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Chapter 7 ABSTRACT BACKGROUND In pa
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Chapter 7 INTRODUCTION Surgical aor
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Chapter 7 two summary measures (the
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Chapter 7 Figure 1. Long-term survi
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Chapter 7 did not differ significan
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Chapter 7 Table 3. Health-related q
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Chapter 7 DISCUSSION This study of
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Chapter 7 surgery were in relative
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Chapter 7 11. Mehta RL, Kellum JA,
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8 Clinical recognition of acute aor
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Clinical recognition of acute aorti
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Chapter 9 ABSTRACT BACKGROUND Trans
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Chapter 9 the diagnosis of atherosc
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Chapter 9 Figure 3. Visualization o
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Chapter 9 Figure 4. Panel A Modifie
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Chapter 9 Figure 7. Modified TEE sh
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Chapter 9 LIMITATIONS OF MODIFIED T
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Chapter 9 14. Flachskampf FA, Woute
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Modified transesophageal echocardio
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Supplement A protocol for the stand
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Supplement Conventional TEE PAA and
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Supplement in perioperative emboliz
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Supplement a stroke risk-reducing p
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Supplement IV. SURGICAL ADAPTATION
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Supplement V. NO SURGERY POSSIBLE T
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Supplement C. TEMPERATURE MONITORIN
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Supplement REFERENCES 1. Royse C, R
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Supplement 29. Lev-Ran O, Loberman
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Summary
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Summary patient outcomes. This thes
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Summary risk, or presence of contra
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Samenvatting
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Samenvatting operatie kan worden to
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Samenvatting echografie toegepast.
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Samenvatting daarom een geschiktere
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List of publications 1. Jansen Klom
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Dankwoord Ongelofelijk trots ben ik
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Dankwoord krijgt, en ben blij dat i
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Dankwoord Lieve “schoonfamilie”
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Curriculum vitae Wouter Jansen Klom
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Proefschrift Jansen Klomp

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