INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND EPIAORTIC ULTRASOUND FOR ASSESSMENT OF ATHEROSCLEROSIS OF THE THORACIC AORTA

Objectives. This study sought to determine the role of transesophageal echocardiography (TEE) and epiaortic ultrasound in the detection of a therosclerosis of the ascending aorta in patients undergoing cardiac s urgery. Background. Atherosclerosis of the ascending aorta is a major risk factor for perioperative stroke and systemic embolism in patients undergoing cardiac surgery. Methods. Forty-four patients underwent pr ospective evaluation of the ascending aorta with two ultrasound techni ques-epiaortic ultrasound and biplane TEE-and by palpation. The severi ty of atherosclerosis was graded on a four-point scale as normal, mild , moderate or severe. Results. A comparison of results with biplane TE E and those with epiaortic ultrasound yielded a kappa value of 0.12 (9 5% confidence interval 0 to 0.25), indicating poor correlation between the two. Compared with epiaortic ultrasound, biplane TEE significantl y underestimated the severity of ascending aortic atherosclerosis, and this underestimation was more marked in the distal ascending aorta (p < 0.0001). When compared with epiaortic ultrasound and biplane TEE, p alpation of the ascending aorta significantly underestimated the prese nce and severity of atherosclerosis (p < 0.0001 for both). Conclusions . Epiaortic ultrasound is more accurate than TEE for identification of atherosclerosis of the ascending aorta, but both ultrasound technique s are superior to palpation. Epiaortic ultrasound and TEE provide comp lementary information regarding thoracic aortic atherosclerosis, Modif ication of surgical technique on the basis of results of intraoperativ e epiaortic ultrasound and TEE in elderly patients undergoing cardiac procedures may prevent atheroembolic complications.