Ohteki H, Itoh T, Natsuaki M, Minato N, Suda H
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Japan.
Ann Thorac Surg. 1990 Oct;50(4):539-42. doi: 10.1016/0003-4975(90)90186-a.
In an attempt to locate any atherosclerotic lesion in the ascending aorta and to prevent embolization, intraoperative B-mode ultrasonography was performed in 100 patients with ischemic heart disease (31 women and 69 men). Ultrasonography was carried out with a 10-MHz probe placed directly on the ascending aorta. Ultrasonic imaging demonstrated an atherosclerotic lesion in the lower half of the aorta in 76 patients (76%), a lesion in the upper half of the aorta in 89 patients (89%), and a lesion at the orifice of the innominate artery in 99 patients (99%). Prospective palpation identified an atherosclerotic lesion in 12 (25%) of 48 patients. Thoracic computed tomography in 79 patients showed calcification in the lower half of the aorta in 6 patients (7.6%) and in the upper half of the aorta in 11 (13.9%). Palpation and thoracic computed tomography underestimated the frequency of atherosclerotic lesions. Intraoperative ultrasonography accurately identified atherosclerotic disease. This technique allows the surgeon to modify cannulation, aortic clamping, and operative technique to reduce the risk of perioperative stroke due to embolization of atherosclerotic debris from the ascending aorta.
为了确定升主动脉中的任何动脉粥样硬化病变并预防栓塞，对100例缺血性心脏病患者（31名女性和69名男性）进行了术中B型超声检查。使用直接置于升主动脉上的10兆赫探头进行超声检查。超声成像显示，76例患者（76%）的主动脉下半部有动脉粥样硬化病变，89例患者（89%）的主动脉上半部有病变，99例患者（99%）的无名动脉开口处有病变。前瞻性触诊在48例患者中的12例（25%）中发现了动脉粥样硬化病变。79例患者的胸部计算机断层扫描显示，6例患者（7.6%）的主动脉下半部有钙化，11例患者（13.9%）的主动脉上半部有钙化。触诊和胸部计算机断层扫描低估了动脉粥样硬化病变的发生率。术中超声检查准确地识别了动脉粥样硬化疾病。这项技术使外科医生能够改变插管、主动脉钳夹和手术技术，以降低因升主动脉粥样硬化碎片栓塞导致围手术期中风的风险。
