Epicardial and Epiaortic Echocardiography

Question 1

What are the highest risk of stroke in cardiac surgeries?

Answer 1

1. MVR (8.8%)
2. CABG + Valve (7.4%)
3. AVR (4.8%)
4. CABG (3.8%)
5. Off pump CABG (1.9%)

Question 2

What percent of patients develop cognitive dysfunction after cardiac surgery?

(One months? 6 months? 5 years?)

Answer 2

30-50% within one month

20-40% at six months

42% at 5 years

Question 3

What are the risk factors for atherosclerosis in the ascending aorta?

Answer 3

Old age

HTN

Unstable angina

COPD

Stroke

PVD
Elevated Creatinine

Question 4

What % of patients with 5mm or mobile plaque will have a stroke?

Answer 4

45%

Question 5

How is the epiaortic ultrasound oriented?
Where do you put the ultrasound marker?

Answer 5

V (On the image) is pointed towards patient left shoulder

Indicator oriented towards left shoulder

Question 6

What are the 5 standard views of the Epiaortic Exam?

Answer 6

1. SAX of Proximal Ascending Aorta

Sinotubular Junction –> Proximal PA

2. SAX of Mid Ascending Aorta

Adjacent to the Right PA

3. SAX of Distal Ascending Aorta

From Right PA to the take off of innominate artery

4. LAX of Ascending Aorta

5. LAX of arch including all arch vessels

Question 7

Label the following vessels

Answer 7

Big Circle = Mid Ascending Aorta

SVC = Small vessel on the right

Right PA at the bottom

Question 8

Label the Long axis of the Epiaortic Exam

Answer 8

Aorta on top

Left = Proximal

Right = Distal

RPA (Bottom screen)

Question 9

What is Grade 1 of Plaque Grading?

Answer 9

Normal Intimal Thickening

Question 10

What is Grade 2 of Plaque Grading?

Answer 10

Severe Intimal Thickening without protruding atheroma

Question 11

What is Grade 3 of Plaque Grading?

Answer 11

Atheroma 3-5 mm

Question 12

What is Grade 4 of Plaque Grading?

Answer 12

Atheroma >5 mm

Question 13

What is Grade 5 of Plaque Grading?

Answer 13

Mobile component

Question 14

What are the major decisions that can be made with epiaortic ultrasound?

Answer 14

1. Unplanned circulatory arrest
2. Avoidance of cross clamp
3. Off Pump CABG
4. Changing Arterial Cannulation Site (Change from aortic to axillary or femoral)
5. Endarterectomy

Question 15

Label 1

Answer 15

RV

Question 16

Label 2

Answer 16

Pulmonic Valve

Question 17

Label 3

Answer 17

Right Coronary Cusp

Question 18

Label 4

Answer 18

Left Coronary Cusp

Question 19

Label 5

Answer 19

Non-Coronary Cusp

Question 20

Label 6

Answer 20

Main Pulmonary Artery

Question 21

Label 7

Answer 21

Left Pulmonary Artery

Question 22

Label 8

Answer 22

Right Pulmonary Artery

Question 23

Label 9

Answer 23

Left Atrium

Question 24

Label 10

Answer 24

Right Atrium

Question 25

Label 11

Answer 25

Inter atrial septum

Question 26

Label 12

Answer 26

Tricuspid Valve