Intraoperative monitoring of elephant trunk kinking with transesophageal echocardiography.

摘要

THE ELEPHANT TRUNK PROCEDURE was first described in 1983 by Borst et al to facilitate repair of complex aortic aneurysms. Several modifications of the procedure have been developed, but the principle of a graft that can be unfolded distally and used as a proximal anastomosis site or endovascular stent landing site in a second descending aortic aneurysm repair has persisted. Intraoperative transesophageal echocardiography (TEE) has become an important adjunct in aortic repairs. The use of TEE guidance and monitoring in the second-stage stent grafting of an elephant trunk has been reported before. Intraoperative TEE may also be important in identifying problems with folding and kinking of these grafts during initial placement and deployment. The authors de'scribe 2 cases in which TEE identified improper unfolding of an elephant trunk during initial placement in ascending aortic and aortic arch repair and elephant trunk kinking during stent-graft placement.