Contrast-Enhanced TEE During Thoracic Endovascular Aortic Repair Procedure.

Contrast transesophageal echocardiography (cTEE) was superior to both TEE and angiography (ANGIO) alone in the assessment of slow flow and remaining flow in the false lumen/aneurysmal sac after stent-graft implantation and in the detection of incomplete stent-graft apposition. (A) TEE demonstrated the presence of type B dissection with evidence of malperfusion. After stent deployment and true lumen expansion guided by ANGIO (B) and TEE (C), there was no evidence of tears on color flow mapping (D). Contrast administration (Sonovue 2.5 ml, Bracco, Milan, Italy) demonstrated new distal intimal tears after stent-graft positioning (E) that were not visible on ANGIO (F) and TEE (Online Video 1), as bubbles move from the true lumen to the false lumen (arrow). (G) Post-operative computed tomography shows complete exclusion and thrombosis of the false lumen.