Ascending aortic atheroma assessed intraoperatively by epiaortic and transesophageal echocardiography

Background. The presence of ascending aortic atheroma is a known risk for s ystemic emboli or early saphenous vein graft failure if unrecognized at the time of cardiopulmonary bypass. Methods. This study prospectively compared intraoperative omniplane transes ophageal echocardiography (TEE) and epiaortic ultrasound (EAU) images in 22 patients (6 women, 16 men, age 66 +/- 8 years) before surgical manipulatio n of the ascending aorta. Atheroma lesion severity was scored: 1 = normal, 2 = nonprotruding intimal thickening (> 2 mm), 3 = atheroma less than 4 mm +/- Ca++, 4 = atheroma greater than or equal to 4 mm +/- Ca++, and 5 = any size mobile or ulcerated lesion +/- Ca++. The ascending aorta between the a ortic valve and innominate artery was divided into proximal, middle, and di stal segments. A total of 66 segments were evaluated. Results. Although the overall agreement of scores between procedures was 75 .8%, significantly more lesions were identified by EAU (15) than by TEE (5) (p < 0.03). TEE failed to identify lesions in the middle and distal segmen ts of the aorta with a score of more than 3. Conclusions. Although atheromatous lesions were identified in the ascending aorta by both ultrasound modalities, the results suggest that intraoperati ve EAU may have an advantage over TEE for surgeons assessing target sites f or surgical procedures involving the ascending aorta. (Ann Thorac Surg 2000 ;70:25-30) (C) 2000 by The Society of Thoracic Surgeons.