Intraoperative ultrasonographic evaluation of the ascending aorta in 100 consecutive patients undergoing cardiac surgery
Davila-Roman, V.G.; Barzilai, B.; Wareing, T.H.; Murphy, S.F.; Kouchoukos, N.T.
Circulation 84(5): III47-III53
1991
ISSN/ISBN: 0009-7322 PMID: 1934441 Document Number: 371503
Dislodgement of atheromatous plaque from the ascending aorta following manipulation is one of the principal causes of stroke following cardiac surgery. To define clinical correlates that predict the presence of severe atherosclerosis, we performed ultrasonographic evaluation of the ascending aorta at the time of cardiac surgery in 100 consecutive patients. The ascending aorta was divided into three equal segments for analysis, and the severity of atherosclerosis was determined as mild when intimal thickening (< 3 mm) was localized to one segment, moderate when intimal thickening (> 3 mm) was present in one or two segments, and severe when intimal thickening (> 3 mm) was present throughout the entire circumference in all three segments. Thirty-eight precent of the studies were normal, mild atherosclerosis was present in 33%, moderate atherosclerosis in 19%, and severe atherosclerosis in 10% of the patients. Palpation of the ascending aorta to detect atherosclerosis significantly underestimated the presence (p < 0.001) and severity (p < 0.001) of atherosclerosis when compared with ultrasonography. Age, carotid artery disease, diabetes, gender, smoking, and hypertension were evaluated for their ability to discriminate between normal and severely atherosclerotic aortas. Stepwise logistc regression analygis showed age (p < 0.02) and diabetes (p < 0.04) to be significant independent predictors of the presence of severe atherosclerosis in the ascending aorta. Based on the ultrasonographic findings, the operative procedure was altered to reduce the risk of embolization in 17% of the patients. We conclude that high-resolution images of the ascending aorta for identification of atherosclerosis can be obtained by ultrasonography. Intraoperative ultrasonographic imaging of the ascending aorta, combined with alterations in operative techique when severe atherosclerosis is detected, may reduce the incidence of stroke due to embolization of atherosclerotic material.