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• W2054167029 abstract "Intentamos determinar el papel de la ecocardiografía transesofágica (ETE) en la descripción preoperatoria de la anatomía funcional de la insuficiencia aórtica (IAo) para identificar candidatos a cirugía conservadora (CCVAo).En 66 pacientes intervenidos de IAo severa se determinan precisión y valores diagnósticos de la ETE en la descripción de lesiones y mecanismos, empleando la observación quirúrgica como referencia. Se valora la utilidad de la ETE para predecir aplicabilidad de técnicas de CCVAo.La exactitud diagnóstica general de la ETE es excelente (87%, índice kappa = 0,82); el prolapso presenta la principal discrepancia (23/27 casos; 85%) entre los métodos. Tres formas anatómicas de dilatación de aorta ascendente (AA) fueron correctamente clasificadas (precisión, > 88%; kappa = 0,83): aneurisma de AA supratubular (19), aneurisma de raíz (4) o anuloectasia aórtica (24). La precisión en el diagnóstico del mecanismo fue del 85% (kappa = 0,8) y éste presentó una asociación significativa con el éxito de la CCVAo (p < 0,001) en el 73% de los casos de dilatación de los anillos funcionales (tethering). El 78% de prolapsos, el 90% de movimiento restrictivo de velos engrosados y el 100% de perforaciones requirieron sustitución valvular aórtica. Las formas de aneurisma también se relacionaron con el procedimiento de sustitución de AA (p = 0,004).La ETE permite una descripción precisa de los mecanismos de la IAo, tiene una elevada tasa de acuerdo con las observaciones quirúrgicas y predice adecuadamente la aplicabilidad de la CCVAo y el procedimiento de sustitución de AA.The aim was to evaluate the usefulness of transesophageal echocardiography (TEE) for the preoperative functional anatomical assessment of patients with aortic regurgitation (AR) to identify those eligible for valve-sparing surgery (VSS).We determined the accuracy and diagnostic value of TEE for identifying underlying lesions and mechanisms in 66 patients who underwent surgery for severe AR by comparing TEE findings with those obtained on surgical inspection. The usefulness of TEE for predicting the feasibility of VSS was determined.The overall diagnostic accuracy of TEE was excellent (87%, kappa=0.82), with valve prolapse being the principle cause of discrepancy between the methods (in 23/27 cases; 85%). Three anatomical forms of dilatation of the ascending aorta (AA) were correctly classified (accuracy >88%; kappa 0.83): supratubal aneurysm (19 patients), aortic root aneurysm (4), and annuloaortic ectasia (24). The mechanism underlying AR was identified with an accuracy of 85% (kappa 0.8) and there was a significant association between the type of mechanism identified by TEE and the success of VSS (P<.001): VSS was successful in 73% of patients with dilatation of a functional annulus (i.e. with tethering), but aortic valve replacement was required in 78% with prolapses, 90% with thickened leaflets with restricted movement, and 100% with perforation. There was also a relationship between the type of aneurysm and the technique required for AA replacement (P=.004).Use of TEE enabled the mechanism underlying AR to be accurately identified. There was a high level of agreement with surgical inspection and the technique was useful for predicting the feasibility of VSS and the surgical procedure for AA replacement." @default.
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• W2054167029 date "1995-09-01" @default.
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• W2054167029 title "Multiple organ complications in DeBakey type 1 aortic dissection: Ascending aorta replacement of ascending aorta with aortic arch?" @default.
• W2054167029 doi "https://doi.org/10.1016/0967-2109(95)94061-z" @default.
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