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Intraoperative ultrasonic imaging of the ascending aorta
W G Marshall1, B Barzilai, N T Kouchoukos
1Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Insights
Intraoperative ultrasonography effectively identifies ascending aorta atherosclerosis, a key stroke risk during cardiac surgery. This imaging allows surgeons to modify techniques, reducing embolization and perioperative stroke risk.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Embolization of atherosclerotic material from the ascending aorta is a significant cause of stroke during cardiac surgery.
- Identifying patients with ascending aorta atherosclerosis is crucial for preventing perioperative stroke.
Purpose of the Study:
- To evaluate the efficacy of intraoperative B-mode ultrasonography in detecting atherosclerotic disease of the ascending aorta.
- To compare ultrasonography findings with traditional visual and tactile examination.
Main Methods:
- Intraoperative B-mode ultrasonography was performed on 50 patients undergoing cardiac surgery.
- The ascending aorta was imaged from the aortic annulus to the innominate artery.
- Ultrasonography results were compared with visual and tactile assessment.
Main Results:
- Ultrasonic imaging detected atherosclerosis in 58% of patients (29/50), while visual/tactile examination identified it in only 24% (12/50).
- Atherosclerosis requiring modification of surgical technique (cannulation, grafting, perfusion) was identified in 24% of patients (12/50), all over 65.
- Palpation significantly underestimates the presence and extent of ascending aorta atherosclerosis.
Conclusions:
- Intraoperative ultrasonography is a superior method for identifying ascending aorta atherosclerosis compared to palpation.
- This imaging technique enables surgeons to adjust surgical strategies, thereby reducing the risk of stroke caused by atherosclerotic debris embolization.
Abstract:
Embolization of atherosclerotic material from the ascending aorta resulting from placement of cannulas or vascular clamps is a major cause of stroke during cardiac surgical procedures. In an effort to identify atherosclerotic disease of the ascending aorta which might predispose to embolization, intraoperative B-mode ultrasonography was performed in 50 patients. The aorta was imaged from the aortic annulus to the origin of the innominate artery in transverse and longitudinal views. The results were compared with visual and tactile examination of the aorta for the presence of atherosclerosis. Ultrasonic imaging demonstrated atherosclerotic disease in 29 patients (58%). Visual examination and palpation identified atherosclerosis in 12 patients (24%). The amount and location of plaque was sufficient to require a change in the site of arterial cannulation or the proximal vein graft anastomoses or the technique of cardiopulmonary perfusion in 12 of the 50 patients (24%). All 12 patients were 65 years of age or older. Palpation underestimates the presence of atherosclerotic disease in the ascending aorta. Intraoperative ultrasonography accurately identifies patients with atherosclerotic disease of the ascending aorta. This allows the surgeon to modify cannulation, perfusion, and operative techniques to reduce the risk of perioperative stroke due to the embolization of atherosclerotic debris from the ascending aorta.