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Atherosclerosis of the ascending aorta as a major determinant of the outcome of cardiac surgery

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 246–251 (2005)Cite this article

Abstract

Epiaortic ultrasonography has high sensitivity for the detection of atherosclerosis. In several studies, the technique has identified atherosclerosis of the ascending aorta as the major risk factor for stroke after cardiac surgery. The level of risk depends on the presence, location and extent of disease when the ascending aorta is surgically manipulated. This knowledge enables clinicians to focus on the diagnostic and surgical technique and to consider the various options. Routine use of intraoperative epiaortic ultrasonography should be applied so that surgical manipulation of the ascending aorta can be reduced or, if possible, avoided in patients with atherosclerosis of the ascending aorta. Alternatively, if major manipulation such as clamping must be performed in the presence of severe atherosclerosis, the use of intra-aortic filters could be considered.

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Author information

Author notes

  1. Per Bergman and Jan van der Linden: P Bergman is a Clinical Investigator and Consultant Cardiothoracic Surgeon, and J van der Linden is a Clinical Professor of Anesthesiology and Intensive Care

Authors and Affiliations

  1. Department of Cardiothoracic Surgery & Anesthesiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

    Per Bergman & Jan van der Linden

Authors
  1. Per Bergman
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  2. Jan van der Linden
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Correspondence to Per Bergman.

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Competing interests

P Bergman and J van der Linden have been members of the International Council of Emboli Management (ICEM) Study Group, which was sponsored by EMBOL-X Inc, Mountain View, CA, who manufacture intra-aortic filters

Glossary

TYPE I NEUROLOGIC INJURY

Focal injury, stupor or coma at discharge from hospital

EPIAORTIC ULTRASONOGRAPHY

Ultrasound scanning in which the transducer is placed directly on the aorta to assess atherosclerosis

HARD-SHELL STANDOFF

Part of the probe that distances the ultrasonic transducer from the aorta to enable sharp focus of surface structures very close to the device tip

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Bergman, P., van der Linden, J. Atherosclerosis of the ascending aorta as a major determinant of the outcome of cardiac surgery. Nat Rev Cardiol 2, 246–251 (2005). https://doi.org/10.1038/ncpcardio0192

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