Abdominal Aorta and Visceral Arteries Visualized by Transgastric Echocardiography : technical considerations

Despite the necessity of information regarding the abdominal aorta and visceral arteries during cardiovascular surgery, there has been no intraoperative modality available. We examined the feasibility and limitations of transesophageal echocardiography (TEE) for this purpose. In 21 consecutive patients, the celiac artery (CEA), superior mesenteric artery (SMA), and left and right renal arteries (LRA, RRA) were examined with TEE, and could be visualized in 21 cases (100%), 20 cases (95.2%), 14 cases (66.7%) and 14 cases (66.7%), respectively. Several attempts were needed for successfully visualizing the LRA and the RRA in 2 and 1 case(s), respectively. Three specific manipulations of the probe were helpful for visualizing these vessels: 1) an appropriate counterclockwise rotation and an upward flexion of the probe when the transducer entered the stomach; 2) a stiffening of the flexible portion of the probe at the position of upward flexion by fixing the handle of the TEE probe when the transducer was advanced; and 3) a lateral flexion of the probe to provide a rotation of the image in either the clockwise or counterclockwise direction and to optimize the assessment of the blood flow velocity in the branch artery. Inferior visualization of the renal arteries was a limitation of this method. Two solutions for this problem were 1) repeated attempts at visualization and 2) an examination of the blood flow in the renal parenchyma with color Doppler imaging. Because of possible damage to the gastric wall, it is recommended that this maneuver be conducted by an experienced sonographer.