• Sujeeth Suvarna, Andrew Smith, Jan Stygall, Shyam Kolvecar, Robin Walesby, Michael Harrison, and Stanton Newman.
• Department of Cardiothoracic Surgery The Heart & UCL Hospitals, London, United Kingdom.
• J. Cardiothorac. Vasc. Anesth. 2007 Dec 1; 21 (6): 805-9.

ObjectivesThere are a number of techniques available to assess the aorta for atheromatous disease in the intraoperative period. This study compared the relationship among the findings of digital palpation (DP), transesophageal echocardiography (TEE), and epiaortic ultrasound (EAU) in the detection of atheroma in the ascending aorta.DesignA prospective, observational study.SettingA single-institution, cardiothoracic specialty hospital.ParticipantsOne hundred fifty-four patients undergoing elective cardiac surgery.InterventionsThe ascending aorta of patients undergoing elective coronary artery bypass surgery was assessed for atheroma by means of the 3 techniques. Atheroma was scored as present or absent. The sensitivity and specificity of the techniques were compared.Measurements And Main ResultsAssuming EAU provides the "gold standard," the sensitivity of both TEE and DP were low. Digital palpation identified only 20 patients (12%); TEE 31 patients (20%); and, in contrast, EAU detected atheroma in 81 patients (53%). There were 3 and 6 false-positives by DP and TEE, respectively.ConclusionAssuming EAU as the "gold standard" to detect atheroma, this study has shown that when assessing the ascending aorta neither DP nor TEE appear sensitive. This study supports the proposal that detection of atheroma should be performed by EAU.

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