Intraoperative Imaging for Porcelain Aorta

Intraoperative Imaging for Porcelain Aorta

Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Intraoperative epiaortic  echocardiography along with manual palpation during surgery has been described as the most sensitive technique for detecting ascending aortic atheroma and calcification [1].

A prospective study evaluated this in hundred consecutive patients undergoing coronary bypass or valve surgery [2]. Ascending aorta was assessed by manual palpation by the operating surgeon, intraoperative transesophageal echocardiography and epiaortic ultrasound using linear and phased-array imaging. No difference was noted between linear and phased array probes. But epiaortic probes were superior to manual palpation in all segments of the aorta. It was also superior to transesophageal echocardiography in mid and distal segments of ascending aorta.

The study concluded that intraoperative epiaortic ultrasound with either a linear or phased array transducer was the best method for detection of ascending aortic atheroma. It was mentioned that transesophageal echocardiography was an insensitive technique for evaluation of mid and distal ascending aortic atheroma. Hence it would be of little value in guiding surgical manipulations such as cross-clamping. It may be noted that preoperative computed tomography is quite useful in evaluating in ascending aortic calcification [3].

References

1. Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Porcelain aorta: a comprehensive review. Circulation. 2015 Mar 3;131(9):827-36. doi: 10.1161/CIRCULATIONAHA.114.011867. Erratum in: Circulation. 2015 Mar 24;131(12):e386. PMID: 25737502.
2. Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF, Tonkin AM. The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. J Cardiothorac Vasc Anesth. 1997 Oct;11(6):704-7. doi: 10.1016/s1053-0770(97)90161-0. PMID: 9327309.
3. Bapat VN, Attia RQ, Thomas M. Distribution of calcium in the ascending aorta in patients undergoing transcatheter aortic valve implantation and its relevance to the transaortic approach. JACC Cardiovasc Interv. 2012 May;5(5):470-476. doi: 10.1016/j.jcin.2012.03.006. PMID: 22625183.