Extracorporeal circulation before and after ultrasonographic evaluation ofthe ascending aorta

Background. To further gain insight into atheroembolization mechanisms epia ortic two-dimensional echocardiographic evaluation before extracorporeal ci rculation and after decannulation may be helpful. Methods. Epiaortic two-dimensional echocardiography was performed before ca nnulation and after decannulation in 188 (124 men) patients (mean age, 67.7 years; range, 43 to 86 years) undergoing operation with extracorporeal cir culation for ischemic heart disease during 1996. Results, After decannulation, a new intimal lesion was recognized in 10 of 188 patients (5.3%): mobile type in 5 patients (3 ending with a stroke [60% ], 2 having brain computed tomographic scans compatible with embolism), int imal tear in 2, and intimal irregularity in 3 patients. Stroke occurred in a significantly smaller number of patients (2 of 178 [1.1%]; p < 0.001) wit hout new lesions. Conclusions. Clamp- or cannula-induced new lesions, especially of mobile ty pe, are often complicated by postoperative stroke. Aggressive surgical tech nique modifications may need to be considered to avoid creating new lesions , particularly of the mobile type, (C) 1999 by The Society of Thoracic Surg eons.