THE INTRAOPERATIVE ASSESSMENT OF ASCENDING AORTIC ATHEROMA - EPIAORTIC IMAGING IS SUPERIOR TO BOTH TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND DIRECT PALPATION

Objectives: To determine the optimal method for detecting ascending ao rtic atheroma intraoperatively by comparing manual palpation by the op erating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging); and to assess risk factors for severe aortic atheroma. Design: A longitudinal prospe ctive study, Assessment of the atheroma by manual palpation was blinde d to the results of the ultrasound images. Setting: The study was perf ormed in a single university tertiary referral hospital. Participants: One hundred consecutive patients undergoing coronary bypass or valve surgery were studied after their written, informed consent. Interventi ons: Potential risk factors were evaluated by both a patient questionn aire and examination of prior hospital records. The ascending aorta wa s assessed by the following methods: manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaort ic ultrasound (linear and phased-array imaging) performed by an echoca rdiologist, For analysis, the ascending aorta was divided into three e qual segments: proximal, mid, and distal, corresponding to regions of different operative manipulations. Measurements and Main Results: Age older than 70 years and hypertension were significant: risk factors fo r severe ascending aortic atheroma with adjusted odds ratios of 3.3 (9 5% CI, 1.2 to 9.3) and 3.9 (95% CI, 1.3 to 12.0), respectively. There was no significant difference in atheroma detection between the two ul trasonic epiaortic probes in any segment; however, epiaortic probes we re superior to manual palpation in all segments and also superior to t ransesophageal echocardiography in the mid and distal segments of the ascending aorta. Conclusions: Age older than 70 years and hypertension are significant risk factors for severe ascending aortic atheroma. In traoperative detection of ascending aortic atheroma is best achieved b y epiaortic ultrasound with either a linear or phased array transducer . Transesophageal echocardiography is an insensitive technique for eva luation of mid and distal ascending aortic atheroma and, therefore, of little value in guiding surgical manipulations such as cross-clamping . Copyright (C) 1997 by W.B. Saunders Company.