Transcutaneous detection of aortic arch atheromas by suprasternal harmonic imaging.
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.
Schwammenthal
Ehud
E
Heart Institute and Cardiac Rehabilitation Institute, Tel Hashomer, Israel. sehud@post.tau.ac.il
Schwammenthal
Yvonne
Y
Tanne
David
D
Tenenbaum
Alexander
A
Garniek
Alex
A
Motro
Michael
M
Rabinowitz
Babeth
B
Eldar
Michael
M
Feinberg
Micha S
MS
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