Trans-Esophageal Echocardiography of the Descending Aorta and Celiac Trunk as an Intraoperative Monitoring for Median Arcuate Ligament Syndrome (MALS) Treatment: Technique Proposal and Two Case Reports
Marta Lubian,
Fulvio Nisi,
Enrico Giustiniano,
Umberto Ripani,
Federico Piccioni,
Maurizio Cecconi
Affiliations
Marta Lubian
Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Milan, Italy
Fulvio Nisi
Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Milan, Italy
Enrico Giustiniano
Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Milan, Italy
Umberto Ripani
Pain Therapy Center, Division of Clinical Anesthesia, Department of emergency, Hospital Riuniti, Via Conca 71, 60126 Ancona, Italy
Federico Piccioni
Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Milan, Italy
Maurizio Cecconi
Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Milan, Italy
Dunbar syndrome is caused by the compression of the celiac artery by the median arcuate ligament (MAL) and the diaphragmatic crura, presenting with abdominal pain. The treatment is surgical, with the aim of dissecting and separating the diaphragmatic crura from the celiac axis, restoring blood flow in the celiac trunk. We propose the use of transesophageal echocardiography to measure the peak systolic velocity in the celiac trunk and to evaluate, in real time, the efficacy of the surgery during MAL resection. Two clinical cases with practical implications are reported. In one of these, the ultrasound exam was useful in providing an intraoperative confirmation of the outcome of the resection.
