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Epidural/Echo/Coagulation

Preoperative CT or intraoperative epi-aortic ultrasound for the diagnosis of atherosclerosis of the ascending aorta? a preliminary report: 058

Bergman, P.1; van der Linden, J.1; Forsberg, K.2; Öhman, M.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 29

Introduction: Extensive atherosclerotic disease, usually first diagnosed intraoperatively, is the most important risk factor for postoperative stroke after cardiac surgery. The aim of this study was to investigate if preoperative computer tomograpy (CT) is comparable with intraoperative epi-aortic ultrasound to diagnose severe atherosclerosis in the ascending aorta.

Method: The study included 20 consecutive patients undergoing elective coronary artery bypass surgery (CABG). Preoperative CT evaluation of the ascending aorta was compared with intraoperative epi-aortic ultrasound findings. The ascending aorta was divided into 12 segments per patient giving in total 240 segments to compare.

Results: Epi-aortic ultrasound detected atherosclerosis in 16.7 ± 2.4% of the segments, which was significantly higher than with CT (P ≤ 0.03). There was a low reliability between the two methods with Kappa Coefficients of 0.45 or lower.

Conclusions: The CT method is inferior to epi-aortic ultrasound, today's gold standard, in diagnosing the extent and location of atherosclerosis of the ascending aorta. Other methods should be sought, possibly magnetic resonance imaging.

References:

1 Davila-Roman VG, Phillips KJ, Daily BB, et al. Intraoperative transoesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta. J Am Coll Cardiol 1996; 28(4): 942-947.
2 van der Linden J, Hadjinikolaou L, Bergman P, et al. Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta. J Am Coll Cardiol 2001; 38(1): 131-135.
3 Bergman P, Hadjinikolaou L, van der Linden J. A policy to reduce stroke in patients with extensive atherosclerosis of the ascending aorta undergoing coronary surgery. Eur J Cardiothorac Surg (In press).
    © 2004 European Society of Anaesthesiology