Abstract 558: The Added Value of Real Time, Three Dimensional Transesophgeal Echocardiography in the Evaluation of Thoracic Aortic Atherosclerosis
Background: Thoracic aortic atherosclerosis (ATH) demonstrated by conventional two dimensional (2D) transesophageal echocardiography (TEE) is associated with stroke and other embolic events. Real time, three dimensional (RT3D) TEE probes are currently available. This study was performed to evaluate the feasibility and the added value of RT3D TEE in the evaluation of ATH.
Methods: 352 patients underwent TEE for clinical indications using a 2D/3D TEE probe. All patients underwent 2D TEE, which included evaluation of the thoracic aorta, and RT3D TEE using the 3D zoom acquisition mode. The severity of ATH by 2D was graded I – V according to the criteria defined by Katz et al.
Results: On 2D TEE, 59/352 pts were diagnosed as normal. They all had no evidence of atherosclerotic plaque and the intima appeared smooth with normal thickness (< 1mm). 3D images of the descending thoracic aorta were obtained in 330/352 pts (94%) and of the aortic arch in 306/352 pts (87%). Normal intima on RT3D TEE was smooth and homogenous (fig 1⇓) while atherosclerotic aorta revealed a grossly irregular surface. The size, shape and mobility (when present) of each plaque could be assessed (fig 2⇓). Intimal ulcerations could be assessed and mapped. Clear evidence of aortic plaque, with a distinct and well demarcated acoustic signal (albeit smooth appearing, flat, and non-calcified), was found by RT3D in 18/59 pts (38%) considered to have a normal aorta by 2D TEE (fig 3⇓ & 4⇓ from the same pt).
Conclusion: Evaluation of the aortic arch and the descending thoracic aorta is highly feasible by RT3D TEE. This method appears to be more sensitive than 2D TEE and may enable the diagnosis of atherosclerotic disease at an earlier stage.