Page 180 - Read Online

Alberts et al. Vessel Plus 2023;7:34 https://dx.doi.org/10.20517/2574-1209.2023.37 Page 19 of 24

luminal borders, such as ventricular or vascular walls. In postoperative surveillance after endovascular
surgery, it has been shown to be more sensitive and accurate for the detection and classification of endoleak
[114]
compared to CT . Furthermore, during TEVAR procedures, CEUS is feasible and more sensitive in the
detection of endoleaks compared to standard TEE, making it an interesting addition to the perioperative
imaging strategy for the guidance and control of TEVAR procedures [115,116] .

Not surprisingly, ongoing development is made in surgical techniques and devices as well. An interesting
concept is the Endo-Bentall, an endovascular device for AV and ascending aorta replacement . The device
[117]
consists of a transcatheter aortic valve prosthesis connected to an uncovered portion of the stent graft. The
concept device is implanted via the transapical route and uses the AV annulus, sinotubular junction, and
distal ascending aorta as landing zones while the uncovered portion of the stent-graft with coronary stents
[117]
secures coronary perfusion . To date, it has been utilized sporadically with custom-made or modified
devices [118,119] . Alternatively, in one case, off-the-shelve grafts were implanted via the transarterial route .
[120]
Since the aortic root is a complex structure and correct positioning of the device is essential, perioperative
TEE can be a valuable tool for surgical guidance and evaluation, and detection of complications. TEE has
demonstrated right ventricular dysfunction due to coronary obstruction in one published case .
[120]

CONCLUSION
TEE is used during surgery on the aorta for the detection of aortic pathology, guiding of surgical decision
making, and evaluation of the surgical repair. For perioperative echocardiographists, it is essential to know
the key elements of TEE and aortic disease, as summarized in this article. With the developments made in
echocardiography and surgical techniques, TEE remains an invaluable tool in the operation theater, now
and in the future.

DECLARATIONS
Authors’ contributions
Literature search, conception, design, writing of the article: Alberts T, Eberl S, Hermanns H

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.