3-D Imaging for Aortic Plaque Assessment

Abstract

Stroke and neurologic dysfunction continue to complicate cardiac surgery despite improvements in cardiopulmonary bypass. Intra-aortic plaque disrupted during aortic manipulation is a known risk factor contributing to neurologic complications; therefore, avoidance of these plaques during aortic manipulation is important. Intraoperative epiaortic echocardiography, with its high sensitivity and specificity, has become the modality of choice for detecting plaque within the aorta during cardiac surgery and is superior to either transesophageal echocardiography or aortic palpation for this purpose. Recently the matrix x4 three-dimensional (3D) ultrasound probe (Philps Medical Systems) was introduced allowing both real time 3D imaging and electrocardiography-gated “full volume” imaging, which essentially acquires a larger image but requires 8 cardiac cycles. Modification of our routine scanning technique was required, employing a saline (about 30 mL) filled sterile sheath secured with a sterile elastic band (creating a saline pocket). There appears little difference in the sensitivity of either 2D or 3D imaging to detect plaque within the aorta. We found that live 3D was superior to 2D imaging in identifying, localizing, and defining the true extent of plaque in the aorta.