Proefschrift Jansen Klomp

Recommendations

Info

The diagnosis of atherosclerosis of the distal ascending aorta in cardiac surgery patients well known, however, that non-calcified and mobile plaques carry a higher risk of dislodgement and (cerebral) embolization during cardiac surgery. 3,5 In contrast to real-time imaging with echocardiography-based techniques, this cannot be offered with these offline modalities. It has indeed been shown that the sensitivity of CTimaging for aortic atherosclerosis was inferior to EUS 1 and TEE. 40 In the latter study, 47% of TEE-detected severe atherosclerotic plaques were missed with CT imaging. 40 Another interesting new technique for the intraoperative visualization of aortic atherosclerosis is phased-array intra-cardiac echocardiography (ICE). In this technique, an ultrasound unit is placed in the right atrium, through which the aortic valve and proximal ascending aorta can be visualized. 41 Direct intra-aortic echocardiography of the descending aorta using the same device has also been described. 42 To our knowledge, the diagnostic accuracy of both methods for aortic atherosclerosis has not yet been studied however. Some limitations apply to our study. First, since EUS served as the reference test, we could not study the added value of modified TEE compared with the added value of EUS. In daily practice, however, screening for aortic atherosclerosis is initiated with modified TEE, as this is performed before sternotomy. Given its high negative predictive value, surgery can continue as planned when severe atherosclerosis is absent. Depending on location and severity of atherosclerosis, a subsequent EUS examination may be considered to confirm a positive result of modified TEE. Secondly, generalizability may be impaired as modified TEE was mainly performed by two senior anesthesiologists, and all patients were included at a single institution with extensive experience in the field of cardiothoracic surgery. Future research will have to show whether these results can be replicated in other settings and with other, less experienced, observers. Finally, there was a substantial amount of missing data, especially for the results of the index and reference test. The main reason for not undergoing these tests was an unavailability of trained personnel to operate modified TEE or EUS. Thus, it seems reasonable to assume that the missingness of these variables did not depend on patient characteristics, and did therefore not affect validity of the results. Indeed, there were only minor imbalances in the distribution of preoperative characteristics in patients with and without a missing index and/ or reference test (see Supplementary data online, SA). Also, we aimed to minimize any possible bias through multiple imputation of the missing data. To conclude, 45
Chapter 3 detection of atherosclerosis in the DAA with modified TEE was not only accurate, but also offered information beyond that obtained from patient characteristics and transoesophageal echocardiography, which resulted in an improved classification of patients. 46
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
Page 23 and 24: Chapter 2 bronchus and inflated wit
Page 25 and 26: Chapter 2 (e.g., transcatheter aort
Page 27 and 28: Chapter 2 17. Gottesman RF, McKahnn
Page 29 and 30: Chapter 2 45. Royse AG, Royse CF, A
Page 32 and 33: 3 Added value of modified transoeso
Page 34 and 35: The diagnosis of atherosclerosis of
Page 56 and 57: 4 Prognostic value of modified tran
Page 58 and 59: Prognostic value of modified transe
Page 74: Prognostic value of modified transe
Page 77 and 78: Chapter 5 ABSTRACT OBJECTIVE Athero
Page 79 and 80: Chapter 5 We therefore studied the
Page 81 and 82: Chapter 5 Figure 3. Flowchart of de
Page 83 and 84: Chapter 5 MULTIVARIABLE REGRESSION
Page 85 and 86: Chapter 5 Table 2. Operative charac
Page 87 and 88: Chapter 5 STROKE The predicted inci
Page 89 and 90: Chapter 5 describe the indications
Page 91: Chapter 5 15. Jansen Klomp WW, Peel
Page 95 and 96: Chapter 6 ABSTRACT BACKGROUND Modif
Page 97 and 98:
Chapter 6 INTRODUCTION Presence of
Page 99 and 100:
Chapter 6 as a normal aorta or exte
Page 101 and 102:
Chapter 6 of a different aortic can
Page 103 and 104:
Chapter 6 meet the inclusion criter
Page 105 and 106:
Chapter 6 Modified TEE was performe
Page 107 and 108:
Chapter 6 CLINICAL ENDPOINTS AND QU
Page 109 and 110:
Chapter 6 lead to effective changes
Page 111 and 112:
Chapter 6 with a higher risk of aor
Page 113 and 114:
Chapter 6 REFERENCES 1. van der Lin
Page 115:
Chapter 6 32. Knipp SC, Matatko N,
Page 119 and 120:
Chapter 7 ABSTRACT BACKGROUND In pa
Page 121 and 122:
Chapter 7 INTRODUCTION Surgical aor
Page 123 and 124:
Chapter 7 two summary measures (the
Page 125 and 126:
Chapter 7 Figure 1. Long-term survi
Page 127 and 128:
Chapter 7 did not differ significan
Page 129 and 130:
Chapter 7 Table 3. Health-related q
Page 131 and 132:
Chapter 7 DISCUSSION This study of
Page 133 and 134:
Chapter 7 surgery were in relative
Page 135:
Chapter 7 11. Mehta RL, Kellum JA,
Page 140 and 141:
8 Clinical recognition of acute aor
Page 142 and 143:
Clinical recognition of acute aorti
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156:
Page 159 and 160:
Chapter 9 ABSTRACT BACKGROUND Trans
Page 161 and 162:
Chapter 9 the diagnosis of atherosc
Page 163 and 164:
Chapter 9 Figure 3. Visualization o
Page 165 and 166:
Chapter 9 Figure 4. Panel A Modifie
Page 167 and 168:
Chapter 9 Figure 7. Modified TEE sh
Page 169 and 170:
Chapter 9 LIMITATIONS OF MODIFIED T
Page 171:
Chapter 9 14. Flachskampf FA, Woute
Page 176 and 177:
Modified transesophageal echocardio
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 194:
Supplement A protocol for the stand
Page 197 and 198:
Supplement Conventional TEE PAA and
Page 199 and 200:
Supplement in perioperative emboliz
Page 201 and 202:
Supplement a stroke risk-reducing p
Page 203 and 204:
Supplement IV. SURGICAL ADAPTATION
Page 205 and 206:
Supplement V. NO SURGERY POSSIBLE T
Page 207 and 208:
Supplement C. TEMPERATURE MONITORIN
Page 209 and 210:
Supplement REFERENCES 1. Royse C, R
Page 211 and 212:
Supplement 29. Lev-Ran O, Loberman
Page 214:
Summary
Page 217 and 218:
Summary patient outcomes. This thes
Page 219 and 220:
Summary risk, or presence of contra
Page 222:
Samenvatting
Page 225 and 226:
Samenvatting operatie kan worden to
Page 227 and 228:
Samenvatting echografie toegepast.
Page 229:
Samenvatting daarom een geschiktere
Page 234:
List of publications 1. Jansen Klom
Page 238 and 239:
Dankwoord Ongelofelijk trots ben ik
Page 240 and 241:
Dankwoord krijgt, en ben blij dat i
Page 242:
Dankwoord Lieve “schoonfamilie”
Page 246:
Curriculum vitae Wouter Jansen Klom
show all

Proefschrift Jansen Klomp

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?