title: Intraoperative transesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta.
abstract: OBJECTIVE
  This study sought to determine the role of transesophageal echocardiography (TEE) and epiaortic ultrasound in the detection of atherosclerosis of the ascending aorta in patients undergoing cardiac surgery.
  
  
  BACKGROUND
  Atherosclerosis of the ascending aorta is a major risk factor for perioperative stroke and systemic embolism in patients undergoing cardiac surgery.
  
  
  METHODS
  Forty-four patients underwent prospective evaluation of the ascending aorta with two ultrasound techniques-epiaortic ultrasound and biplane TEE-and by palpation. The severity of atherosclerosis was graded on a four-point scale as normal, mild, moderate or severe.
  
  
  RESULTS
  A comparison of results with biplane TEE and those with epiaortic ultrasound yielded a kappa value of 0.12 (95% confidence interval 0 to 0.25), indicating poor correlation between the two. Compared with epiaortic ultrasound, biplane TEE significantly underestimated the severity of ascending aortic atherosclerosis, and this underestimation was more marked in the distal ascending aorta (p < 0.0001). When compared with epiaortic ultrasound and biplane TEE, palpation of the ascending aorta significantly underestimated the presence and severity of atherosclerosis (p < 0.0001 for both).
  
  
  CONCLUSIONS
  Epiaortic ultrasound is more accurate than TEE for identification of atherosclerosis of the ascending aorta, but both ultrasound techniques are superior to palpation. Epiaortic ultrasound and TEE provide complementary information regarding thoracic aortic atherosclerosis. Modification of surgical technique on the basis of results of intraoperative epiaortic ultrasound and TEE in elderly patients undergoing cardiac procedures may prevent atheroembolic complications.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA. davila@visar.wustl.edu
authors.forename: V G
authors.initials: VG
authors.lastname: Dávila-Román
authors.forename: K J
authors.initials: KJ
authors.lastname: Phillips
authors.forename: B B
authors.initials: BB
authors.lastname: Daily
authors.forename: R M
authors.initials: RM
authors.lastname: Dávila
authors.forename: N T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: B
authors.initials: B
authors.lastname: Barzilai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D006348:Cardiac Surgical Procedures; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011300:Preoperative Care; D011446:Prospective Studies