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CARDIOVASCULAR ANESTHESIA

Echocardiographic and Pathological Evaluation of Atherosclerosis in the Ascending Aorta During Coronary Artery Bypass Grafting

Kumi Matsuyama, MD^*, Tomoko Goto, MD^*, Tomoko Baba, MD^*, Yoshihiro Shibata, MD^*, Yoichiro Otsuka, MD, Ryuzo Sakata, MD, and Hidenori Terasaki, MD^§

Departments of *Anesthesiology, Pathology, Cardiovascular Surgery, Kumamoto Chuo Hospital; and §Department of Anesthesiology, Kumamoto University School of Medicine, Kumamoto, Japan

Address correspondence and reprint requests to Kumi Matsuyama, MD, Department of Anesthesiology, Kumamoto Chuo Hospital, 96 Tainoshima, Tamukaemachi, Kumamoto, 862-0965, Japan.

We performed intraoperative echocardiography with an epiaortic probe to assess the correlation between echocardiographic appearance and pathological findings of the aorta and to examine the effect of cross-clamping on the aortic wall in 276 patients who underwent coronary artery bypass grafting. The ascending aorta was divided into three segments as follows: lower (L), upper (U), and innominate. The anterior (ant) and posterior (post) intimal thicknesses of each of the three segments were measured. The echogenicity at each of the six locations was examined and was classified as isoechoic or nonisoechoic (hyperechoic, hypoechoic, or mixed type). Tissue punched from the ant L wall of the ascending aorta for vein anastomosis was examined for the presence of atheroma. At the ant L, the prevalence of atheroma was significantly higher in nonisoechoic walls than in isoechoic walls (P = 0.049). We divided patients into two groups according to echogenicity at the U segments. Group A (n = 213) consisted of patients whose echogenicities at both ant U and post U were isoechoic. Group B (n = 63) consisted of patients with nonisoechoic echogenicity at ant U and/or post U. The intimal thicknesses at all six locations in Group B patients were greater than those of Group A (P < 0.01). Deformities at the clamp site after cardiopulmonary bypass were observed significantly more often in Group B than in Group A (P < 0.01). Our data suggest that a nonisoechoic aortic wall indicates more advanced atheroma and a higher risk of deformities at the clamp site. Examination of the echogenicity of the ascending aorta may be one method to reduce perioperative neurological complications.

Implications: We performed epiaortic echocardiography during coronary artery bypass grafting and found that the presence of atheroma and deformities at the cross-clamping site were significantly more prevalent in nonisoechoic walls than isoechoic walls.