Aortic atheroma and adverse cerebral outcome: risk, diagnosis, and management options.
Aortic atheromatous disease is a common finding in the patient presenting for cardiac surgery. Adverse neurologic outcome has been closely linked to the extent of aortic atherosclerosis. In order to optimize perioperative outcomes, the location and severity of disease needs accurate characterization using multimodal techniques. Although various preoperative radiographic techniques have variably identified patients with significant atheroma, intraoperative echocardiographic imaging has proven most useful in localizing and characterizing the degree of aortic atheroma. Epiaortic assessment of the ascending aorta has been utilized in guiding surgical modifications and interventions aimed at reducing the risk of neurologic injury. Although no particular technique has been definitely studied, avoidance of the identifiable atheromatous aortic region has been a main feature of the various modifications employed to optimize neurologic outcome after cardiac surgery.
Grocott
Hilary P
HP
Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada. hgrocott@sbgh.mb.ca
Tran
Tony
T
D001011:Aorta / Q000503:physiopathology; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004452:Echocardiography / Q000379:methods; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D019990:Perioperative Care; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control