title: The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation.
abstract: OBJECTIVE
  To determine the optimal method for detecting ascending aortic atheroma intraoperatively by comparing manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging); and to assess risk factors for severe aortic atheroma.
  
  
  METHODS
  A longitudinal prospective study. Assessment of the atheroma by manual palpation was blinded to the results of the ultrasound images.
  
  
  METHODS
  The study was performed in a single university tertiary referral hospital.
  
  
  METHODS
  One hundred consecutive patients undergoing coronary bypass or valve surgery were studied after their written, informed consent.
  
  
  METHODS
  Potential risk factors were evaluated by both a patient questionnaire and examination of prior hospital records. The ascending aorta was assessed by the following methods: manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging) performed by an echocardiologist. For analysis, the ascending aorta was divided into three equal segments: proximal, mid, and distal, corresponding to regions of different operative manipulations.
  
  
  RESULTS
  Age older than 70 years and hypertension were significant risk factors for severe ascending aortic atheroma with adjusted odds ratios of 3.3 (95% CI, 1.2 to 9.3) and 3.9 (95% CI, 1.3 to 12.0), respectively. There was no significant difference in atheroma detection between the two ultrasonic epiaortic probes in any segment; however, epiaortic probes were superior to manual palpation in all segments and also superior to transesophageal echocardiography in the mid and distal segments of the ascending aorta.
  
  
  CONCLUSIONS
  Age older than 70 years and hypertension are significant risk factors for severe ascending aortic atheroma. Intraoperative detection of ascending aortic atheroma is best achieved by epiaortic ultrasound with either a linear or phased array transducer. Transesophageal echocardiography is an insensitive technique for evaluation of mid and distal ascending aortic atheroma and, therefore, of little value in guiding surgical manipulations such as cross-clamping.
authors.affiliation: Department of Cardiology, Austin and Repatriation Medical Centre, Heidelberg, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Sylivris
authors.forename: P
authors.initials: P
authors.lastname: Calafiore
authors.forename: G
authors.initials: G
authors.lastname: Matalanis
authors.forename: A
authors.initials: A
authors.lastname: Rosalion
authors.forename: H P
authors.initials: HP
authors.lastname: Yuen
authors.forename: B F
authors.initials: BF
authors.lastname: Buxton
authors.forename: A M
authors.initials: AM
authors.lastname: Tonkin
mesh_terms: D000367:Age Factors; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007432:Intraoperative Period; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D012307:Risk Factors