title: Transcutaneous detection of aortic arch atheromas by suprasternal harmonic imaging.
abstract: OBJECTIVE
  The goal of the present study was to examine whether suprasternal harmonic imaging (SHI) (i.e., harmonic imaging from the suprasternal windows) can visualize protruding arch atheromas (PAAs) and reliably predict the presence or absence of significant lesions.
  
  
  BACKGROUND
  Protruding arch atheromas are a major source of cerebral and peripheral embolism and probably the most frequent cause of stroke during cardiac catheterization and open-heart surgery. Preprocedural screening by transesophageal echocardiography (TEE) would be desirable but is limited by the nature of the examination.
  
  
  METHODS
  Of 354 patients who underwent a TEE study in our laboratory during the study period, 106 were referred for detection of a source of embolism. Findings were classified based on the French Aortic Plaque study criteria as: 1) no or minimal atherosclerotic changes; 2) PAAs < 4 mm; 3) PAAs > or =4 mm or presence of a mobile component.
  
  
  RESULTS
  Adequate transcutaneous image quality could be achieved in 89 patients (84%). Protruding arch atheromas were present in 42 patients (47%) and absent in 47 (53%). Positive and negative predictive values for large PAAs on TEE were 91% and 98%, respectively. In one case, SHI detected a complex PAA inaccessible for TEE due to interposition of the left bronchus as demonstrated by dual helical computed tomography. Inter-observer agreement for SHI was 91%.
  
  
  CONCLUSIONS
  Suprasternal harmonic imaging reliably predicted or excluded the presence of PAAs in a sizable, consecutive group of patients referred to TEE for detection of a source of embolism. It represents an excellent screening test and provides complimentary views of regions, which may be blind spots for TEE.
authors.affiliation: Heart Institute and Cardiac Rehabilitation Institute, Tel Hashomer, Israel. sehud@post.tau.ac.il
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schwammenthal
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.forename: Alex
authors.initials: A
authors.lastname: Garniek
authors.forename: Michael
authors.initials: M
authors.lastname: Motro
authors.forename: Babeth
authors.initials: B
authors.lastname: Rabinowitz
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
mesh_terms: D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests