Assessment of thoracic aortic atheroma by echocardiography: a new classification and estimation of risk of dislodging atheroma during three surgical techniques.
A new classification is described to improve precision of thoracic atheroma reporting. In 68 patients, the thoracic aorta was screened with epiaortic and transesophageal echocardiography. The thoracic aorta is divided into 6 zones corresponding to sites of aortic manipulation. Zones 1-3, proximal, mid and distal ascending aorta, Zones 4-5, proximal and distal arch and Zone 6, proximal descending aorta. Each zone is further sub-divided into anterior, left lateral, posterior and right lateral quadrants. There is a marked increase in moderate and severe atheroma between Zones 1-3 and Zone 4-6 (p<0. 001). There is a difference in atheroma by quadrant with the anterior the most frequent. (p<0.001) Once the grade and location of atheroma was classified, a comparison of the estimation of risk of dislodging atheroma during three surgical methods for care, was performed. Of 50 quadrants of atheroma, the composite arterial pedicle Y graft CABG would manipulate 5, Aortocoronary CABG with single aorta cross clamp, 16, and Aortocoronary CABG with aortic partial occlusion clamp, 21. This classification of 6 zones and 4 quadrants within each zone will increase the precision of atheroma reporting and allow better comparison of stroke reduction interventions.
Royse
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C
Department of Anaesthesiology, The Royal Melbourne Hospital, P.O. Box 1022, Research, Victoria, Australia, 3095.
Royse
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A
Blake
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D
Grigg
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L
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D001161:Arteriosclerosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome