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Published on: September 8, 2023
Complex aortic plaques: hidden danger in aortic stenosis. Role of transesophageal echocardiography
Lindsay Benites-Yshpilco1, Kelly Cupe-Chacalcaje2, Angela Cachicatari-Beltrán2
1Departamento de Cardiología Clínica, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Departamento de Cardiología Clínica Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru.
Insights
Transesophageal echocardiography (TEE) effectively identifies complex aortic plaques in patients with aortic stenosis undergoing valve replacement. This imaging technique is crucial for assessing stroke risk associated with these plaques.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Aortic stenosis frequently coexists with aortic plaques due to shared risk factors.
- Complex aortic plaques are linked to increased stroke risk, particularly in patients with aortic stenosis undergoing valve interventions.
Purpose of the Study:
- To review the utility of transesophageal echocardiography (TEE) in detecting complex aortic plaques in patients indicated for aortic valve replacement.
- To emphasize the association between aortic stenosis and complex aortic plaques.
Main Methods:
- Review of existing literature and case studies.
- Focus on transesophageal echocardiography (TEE) for thoracic aorta plaque assessment.
- Utilization of 3D TEE for detailed plaque characterization.
Main Results:
- Transesophageal echocardiography (TEE) is the preferred imaging modality for detecting thoracic aortic plaques.
- 3D TEE provides enhanced visualization of plaque dimensions and features like thrombi and ulcers.
- Complex aortic plaques are prevalent in patients with aortic stenosis.
Conclusions:
- TEE is a valuable tool for identifying complex aortic plaques in patients with aortic stenosis.
- Accurate plaque characterization using TEE aids in stroke risk stratification before aortic valve replacement.
- Understanding the association between aortic stenosis and aortic plaques is critical for patient management.
Abstract:
Aortic stenosis is associated with aortic plaques in up to 85% of cases because they share risk factors and pathogenic pathways. Intrinsically, complex aortic plaques carry a high risk of stroke, which has also been demonstrated in the context of aortic stenosis, especially in patients who underwent percutaneous or surgical replacement. Transesophageal echocardiography (TEE) is the imaging test of choice to detect plaques in the thoracic aorta and classify them as complex plaques. Furthermore, the 3D modality allows us to better specify its dimensions and anatomical characteristics, such as added thrombi or the presence of ulcers inside. This review aims to evaluate the use of TEE to detect complex aortic plaques in patients with an indication for percutaneous or surgical aortic valve replacement. To highlight the association between aortic stenosis and complex aortic plaques, we attached to the review some TEE studies from our experience.
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