PATHOLOGICAL CORRELATES OF AORTIC PLAQUES, THROMBI AND MOBILE AORTIC DEBRIS IMAGED IN-VIVO WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Objectives. This study sought to evaluate the pathologic correlates of aortic atheromas, thrombi and mobile ''aortic debris'' imaged in vivo by transesophageal echocardiography (TEE). Background. Atheroscleroti c plaques with various complexity, thrombi and debris are frequently i dentified by TEE during imaging of the aorta. However, pathologic data to characterize these lesions imaged in vivo are lacking, Methods. In traoperative TEE was performed prospectively in 31 patients undergoing repair of aortic aneurysm or dissection. TEE was used to guide the su rgeon to mark aortic areas of interest that were sent for pathologic e xamination. A four-point scoring system was used for both TEE and path ologic evaluation to grade the degree of involvement of the aortic wal l with atheroma. Ultrasound video intensity of the aortic wall lesions was measured and compared with quantitative measures of wall composit ion at pathologic examination. The presence of thrombi and mobile aort ic debris by TEE was noted and compared with pathologic findings. Resu lts. Histologic-TEE correlations sere possible in 62 aortic segments. There was 73% exact agreement between TEE and pathologic grading. Disc repancies were mostly in the inability of TEE to detect superficial ul cerations. However, separation of normal aorta and minimal intimal thi ckening (grades I and II) from more complex atheromas (grades III and IV) was observed in 93%. For identification of thrombus, TEE had a sen sitivity of 91% (29 of 32 segments) and a specificity of 90% (27 of 30 segments). Mobile aortic debris were identified in six aortic segment s and were confirmed at pathologic examination to be thrombi. Ultrasou nd video intensity increased with worsening complexity of atheroma and related significantly to aortic plaque composition at pathologic eval uation (r = 0.80, p < 0.0001), Ultrasound intensity of thrombi and mob ile debris was similar and was lower than that of complex atheromas. C onclusions. Thus, in the evaluation of aortic pathologic segments, TEE can assess aortic plaque complexity and identify thrombus formation, findings that may have important therapeutic implications. (C) 1997 by the American College of Cardiology.