Beyond Palpation, the Educated Finger and Computed Tomography: Expanding the Role of Epi-Aortic Ultrasound in Cardiac Surgery.

Abstract

The presence of atheroma in the aorta represents an aspect of the spectrum of systemic atherosclerosis. Advancing age, presence of diabetes, hypertension and the presence of multiple cardiovascular risk factors are associated with atheromatous disease [ [1] Matsusaki M. Ono S. Tomochika Y. Michishige H. Tanaka N. Okuda F. et al. Advances in transesophageal echocardiography for the evaluation of atherosclerotic lesions in thoracic aorta—the effects of hypertension, hypercholesterolemia, and aging on atherosclerotic lesions. Jpn Cir J. 1992; 56: 592-602 Google Scholar , [2] Tunick P.A. Rosenzweig B.P. Katz E.S. Freedberg R.S. Perez J.L. Kronzon I. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol. 1994; 23: 1085-1090 Google Scholar ]. As expected, the presence of aortic atherosclerosis is not uncommon in patients undergoing cardiac surgery. Indeed, the ageing population presenting for cardiac surgery portends an increased prevalence of atheroma. Aortic atheroma poses risk for perioperative neurological injury; higher grades of atheroma carry a higher risk of neurologic injury. While multiple imaging modalities are available to detect aortic atheroma, there has been no standard strategy in most institutions to detect atherosclerosis in patients undergoing cardiac surgery. In the late 1990s, epi-aortic ultrasound was evaluated in animal models and some clinical explorations were carried out. However, these interesting forays into intraoperative epi-aortic ultrasound (EUS) did not translate into consistent clinical practice [ [3] Sylivris S. Calafiore P. Matalanis G. Rosalion A. Yuen H.P. Buxton B.F. et al. The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. J Cardiothorac Vasc Anesth. 1997; 11: 704-707 Google Scholar ]. Recently, in Heart, Lung and Circulation, Jaffar-Kiraballi et al. presented a systematic review on the use of EUS to detect aortic atherosclerosis and study its influence on postoperative stroke and mortality [ [4] Jaffar-Karballai M. Kayali F. Botezatu B. Satti D.I. Harky A. The rationalisation of intra-operative imaging during cardiac surgery: A systematic review. Heart Lung Circ. 2023; 23: 567-586 Google Scholar ].