Marshall W G, Barzilai B, Kouchoukos N T, Saffitz J
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Ann Thorac Surg. 1989 Sep;48(3):339-44. doi: 10.1016/s0003-4975(10)62852-4.
Embolization of atherosclerotic material from the ascending aorta resulting from placement of cannulas or vascular clamps is a major cause of stroke during cardiac surgical procedures. In an effort to identify atherosclerotic disease of the ascending aorta which might predispose to embolization, intraoperative B-mode ultrasonography was performed in 50 patients. The aorta was imaged from the aortic annulus to the origin of the innominate artery in transverse and longitudinal views. The results were compared with visual and tactile examination of the aorta for the presence of atherosclerosis. Ultrasonic imaging demonstrated atherosclerotic disease in 29 patients (58%). Visual examination and palpation identified atherosclerosis in 12 patients (24%). The amount and location of plaque was sufficient to require a change in the site of arterial cannulation or the proximal vein graft anastomoses or the technique of cardiopulmonary perfusion in 12 of the 50 patients (24%). All 12 patients were 65 years of age or older. Palpation underestimates the presence of atherosclerotic disease in the ascending aorta. Intraoperative ultrasonography accurately identifies patients with atherosclerotic disease of the ascending aorta. This allows the surgeon to modify cannulation, perfusion, and operative techniques to reduce the risk of perioperative stroke due to the embolization of atherosclerotic debris from the ascending aorta.
插管或血管夹放置导致升主动脉粥样硬化物质栓塞是心脏手术过程中中风的主要原因。为了识别可能易发生栓塞的升主动脉粥样硬化疾病，对50例患者进行了术中B型超声检查。从主动脉瓣环到无名动脉起始处，以横向和纵向视图对主动脉进行成像。将结果与对主动脉进行视觉和触觉检查以确定是否存在动脉粥样硬化的结果进行比较。超声成像显示29例患者（58%）存在动脉粥样硬化疾病。视觉检查和触诊发现12例患者（24%）存在动脉粥样硬化。在50例患者中的12例（24%）中，斑块的数量和位置足以要求改变动脉插管部位、近端静脉移植物吻合部位或心肺灌注技术。所有12例患者均为65岁及以上。触诊会低估升主动脉粥样硬化疾病的存在。术中超声检查能准确识别升主动脉粥样硬化疾病患者。这使外科医生能够修改插管、灌注和手术技术，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。
