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The Annals of Thoracic Surgery, Vol 53, 758-761, Copyright © 1992 by The Society of Thoracic Surgeons
GH Ribakove, ES Katz, AC Galloway, EA Grossi, RA Esposito, FG Baumann, I Kronzon and FC Spencer
Stroke is an especially serious complication of cardiopulmonary bypass with
an incidence of 2% to 5%. This prospective study used transesophageal
echocardiography (TEE) in 97 patients more than 65 years of age (mean age,
73 years) to identify those at high risk for aortic atheroemboli. The
atheromatous disease of the aorta was graded by TEE: grade I = minimal
intimal thickening (n = 29); II = extensive intimal thickening (n = 33);
III = sessile atheroma (n = 15); IV = protruding atheroma (n = 10); V =
mobile atheroma (n = 10). Clinical evaluation was also performed by
intraoperative aortic palpation. Four patients who were graded as having
normal aortas by palpation had intraoperative strokes. In contrast, 3 of
these 4 patients were in grade V on TEE. The relationship of TEE to
incidence of stroke was statistically significant (p less than 0.006),
whereas there was no significant correlation between clinical grade and
stroke incidence. Four of 10 TEE grade V patients were treated with
hypothermic circulatory arrest and aortic arch debridement, and none
suffered strokes. The other 6 patients were treated with standard
techniques, and 3 had strokes. These results suggest that patients with
mobile atheromatous disease are at high risk for embolic strokes that are
not predicted by routine clinical evaluation. Selective use of circulatory
arrest in the presence of TEE-detected mobile arch atheromas may reduce the
risk of intraoperative stroke.
ARTICLES
Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch
Department of Surgery, New York University Medical Center, New York 10016.
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