Ibrahim Khalid S, Vitale Nicola, Tromsdal Arve, Kirkeby-Garstad Idar, Fraser Alan G, Haaverstad Rune
Institute of Circulation and Imaging Techniques, Norwegian University of Science and Technology, Norway.
Int J Cardiol. 2008 Aug 18;128(2):218-23. doi: 10.1016/j.ijcard.2007.05.035. Epub 2007 Jul 23.
Intra-operative grading of atheromatous plaques in the ascending aorta by epiaortic ultrasound (EAU) and transesophageal echocardiography (TEE) in patients who have undergone CABG.
Sixty patients scheduled for elective CABG were prospectively enrolled to undergo intra-operative TEE and EAU ultrasound scanning of the ascending aorta. The ascending aorta was divided into three sections; proximal, middle and distal, and four segments; anterior, posterior, medial and lateral. Degree of atherosclerosis was graded according to a modified Montgomery scale. Epiaortic ultrasound was unable to provide images for a reliable assessment in 56 areas (7.7%; 56/720) vs 322 non-visualized areas by TEE (44.7%; 298/720) (p<0.01). Out of 563 areas that scored >or=2, EAU visualized 379/720 areas (52.6%), whereas TEE visualized 184/720 areas (25.5%) (p<0.01). EAU mean scores were significantly higher for the mid (p=0.0001) and distal (p=0.05) sections and for the posterior segment (p<0.01) vs TEE. TEE had a higher mean score than EAU in the anterior segment. When all EAU areas were grouped the posterior segment reached a significantly higher mean score (p<0.01), and the anterior segment was the second mostly diseased.
EAU is the intra-operative investigation of choice because it allowed a detailed grading of atheromatous lesions over the entire length of the ascending aorta. Accurate grading by TEE was restricted only to those areas that could be sufficiently visualized. TEE has a reduced power of investigation that limits its use, especially in the distal ascending aorta, a site of great surgical manipulation.
对接受冠状动脉旁路移植术（CABG）的患者，通过升主动脉超声（EAU）和经食管超声心动图（TEE）在术中对升主动脉粥样斑块进行分级。
前瞻性纳入60例计划接受择期CABG的患者，术中行升主动脉的术中TEE和EAU超声扫描。升主动脉分为三段：近端、中段和远端，以及四个节段：前侧、后侧、内侧和外侧。根据改良的蒙哥马利量表对动脉粥样硬化程度进行分级。EAU在56个区域（7.7%；56/720）无法提供可靠评估图像，而TEE有322个区域无法可视化（44.7%；298/720）（p<0.01）。在563个评分≥2的区域中，EAU可视化了379/720个区域（52.6%），而TEE可视化了184/720个区域（25.5%）（p<0.01）。与TEE相比，EAU在中段（p=0.0001）和远端（p=0.05）节段以及后侧节段（p<0.01）的平均评分显著更高。TEE在前侧节段的平均评分高于EAU。当对所有EAU区域进行分组时，后侧节段的平均评分显著更高（p<0.01），前侧节段是第二大病变部位。
EAU是术中首选的检查方法，因为它能够对升主动脉全长的粥样病变进行详细分级。TEE进行准确分级仅限于那些能够充分可视化的区域。TEE的检查能力较低，限制了其应用，尤其是在升主动脉远端，这是一个手术操作较多的部位。
