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Updated: Jun 27, 2026

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
An argument for routine ultrasound screening of the thoracic aorta in the cardiac surgery population
William S Whitley1, Kathryn E Glas
1Department of Anesthesia, Emory University Hospital, Atlanta, Georgia 30322, USA. wswhitl@emory.edu
Insights
Routine ultrasound screening during cardiac surgery can help diagnose aortic disease, reducing stroke and neurological injury risks. This approach enhances patient safety by identifying atherosclerosis before surgical manipulation.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Cardiac surgery poses risks of stroke and neurological injury, often linked to aortic atheromas.
- Thoracic aortic disease is prevalent in cardiac patients, with ascending aorta manipulation being common.
- Atherosclerotic plaque dislodgement during surgery is a known cause of embolic events.
Purpose of the Study:
- To review the evidence supporting routine ultrasound guidance in cardiac surgery.
- To highlight the diagnostic capabilities of epiaortic ultrasound and transesophageal echocardiography.
- To explore the potential for improved postoperative outcomes through early diagnosis of aortic disease.
Main Methods:
- Review of scientific literature on ultrasound in cardiac surgery.
- Analysis of diagnostic accuracy of epiaortic ultrasound and transesophageal echocardiography.
- Evaluation of the association between aortic manipulation and embolic events.
Main Results:
- Epiaortic ultrasound and transesophageal echocardiography are highly accurate for diagnosing aortic atherosclerosis.
- These imaging modalities are readily accessible to surgical teams.
- Evidence suggests a link between aortic manipulation and embolization.
Conclusions:
- Routine ultrasound screening can identify patients at risk for embolic events during cardiac surgery.
- Implementing ultrasound guidance may mitigate stroke and neurological injury complications.
- Further investigation into the widespread adoption of ultrasound in cardiac procedures is warranted.
Abstract:
Stroke and neurological injury are among the most devastating and disabling complications associated with cardiac surgery. Transesophageal echocardiography and epiaortic ultrasound allow for sensitive, point-of-care diagnosis of thoracic aortic disease, which is especially common in patients with heart disease. Unlike other operative procedures, the manipulation of the ascending aorta is routine in cardiac surgery and often unavoidable. Dislodgement and embolization from the ascending and aortic arch atheromas have been clearly associated with manipulation during cardiac surgery. Epiaortic ultrasound and transesophageal echocardiography screening are more accurate and more accessible to the operative team than any other available modality to diagnose atherosclerosis of the aorta. The goal of this review is to review the rationale and scientific evidence that suggests that the routine use of ultrasound guidance in cardiac surgery may improve postoperative outcomes in this patient population.
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Thoracic Aorta
