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The Annals of Thoracic Surgery, Vol 48, 339-344, Copyright © 1989 by The Society of Thoracic Surgeons
WG Marshall Jr, B Barzilai, NT Kouchoukos and J Saffitz
Embolization of atherosclerotic material from the ascending aorta resulting
from placement of cannulas or vascular clamps is a major cause of stroke
during cardiac surgical procedures. In an effort to identify
atherosclerotic disease of the ascending aorta which might predispose to
embolization, intraoperative B-mode ultrasonography was performed in 50
patients. The aorta was imaged from the aortic annulus to the origin of the
innominate artery in transverse and longitudinal views. The results were
compared with visual and tactile examination of the aorta for the presence
of atherosclerosis. Ultrasonic imaging demonstrated atherosclerotic disease
in 29 patients (58%). Visual examination and palpation identified
atherosclerosis in 12 patients (24%). The amount and location of plaque was
sufficient to require a change in the site of arterial cannulation or the
proximal vein graft anastomoses or the technique of cardiopulmonary
perfusion in 12 of the 50 patients (24%). All 12 patients were 65 years of
age or older. Palpation underestimates the presence of atherosclerotic
disease in the ascending aorta. Intraoperative ultrasonography accurately
identifies patients with atherosclerotic disease of the ascending aorta.
This allows the surgeon to modify cannulation, perfusion, and operative
techniques to reduce the risk of perioperative stroke due to the
embolization of atherosclerotic debris from the ascending aorta.
ARTICLES
Intraoperative ultrasonic imaging of the ascending aorta
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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