Protruding atheromas in the thoracic aorta and systemic embolization

Article Abstract:

Blood clots that form in the heart can break apart, and pieces may travel to distant parts of the body, where they lodge and impair the circulation. This is called systemic embolization, and is manifested by such phenomena as strokes, transient ischemic attacks (stroke-like syndromes that completely resolve in less than 24 hours), and the absence of blood flow to an extremity. People with evidence of systemic emboli are often referred for echocardiograms, or ultrasound imaging of the heart, to attempt to locate the source of these emboli. Transesophageal echocardiography is a relatively new technique, in which the patient swallows the echocardiogram probe and the pictures are transmitted from the inside of the body rather than the chest wall. Transesophageal echocardiography also shows the thoracic aorta, the part of the body's main artery that travels through the chest, and can detect atheromas. Atheromas are fatty deposits in the walls of arteries, a potential source of systemic emboli. A retrospective study of all transesophageal echocardiograms performed to locate the source of systemic emboli was done to determine the frequency of aortic atheromas in patients with such emboli. A total of 122 patients with emboli were compared with 122 patients who underwent transesophageal echocardiograms for other reasons. Atheromas were found in 33 of the subjects with emboli, while only 11 control patients had atheromas. The likelihood of embolic events was 3.2 times greater when atheromas were detected. Even when taking into account high blood pressure and diabetes, two other known causes of stroke, atheromas were still found to increase the risk for emboli. Currently, the only way to remove atheromas is through a procedure that is similar to open-heart surgery. Transesophageal echocardiography appears to be a useful means of detecting atheromas, and may identify those patients at greatest risk for emboli and who might be candidates for surgical removal of their atheromas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Abnormalities

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Atheromatosis of the aortic arch as an occult source of multiple systemic emboli

Article Abstract:

Atheroembolism occurs when fat (lipid) deposits accumulate in the lining of a major artery and block the flow of blood. This condition can occur following surgery or after a catheter has been placed in the abdominal aorta, the major artery that carries blood to the abdominal region. (A catheter is a narrow tube that is usually used to provide fluid to or remove fluid from the body.) Atheroembolism has also been reported during the placement of a catheter in the heart. In some cases, lipid deposits can break loose from the wall of the artery in which they are located, travel in the circulation, and become lodged in a different blood vessel. This can make it difficult to determine the source of an embolism (that is, where the deposits or clotted material came from). Echocardiography is a technique that uses ultrasound to identify abnormalities in heart structure and function. It has been used successfully to identify the presence of plaques (small patches of lipid deposits and/or hardened material) within the aortic arch, the section of the aorta that comes out of the top of the heart and through which blood is circulated to the rest of the body. This article describes the case report of a 53-year-old woman who underwent surgery to remove an embolism from an artery in her right leg. After this operation, she suffered a stroke and required additional surgery to remove blood clots from her left leg. An echocardiogram revealed the presence of a large protruding mass in the aortic arch. Surgery was performed to remove the large mass, and the patient did not have any more emboli. This report suggests that echocardiography provides a useful technique for identifying potential sources of emboli within the aortic arch. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Diagnosis, Risk factors, Physiological aspects, Echocardiography, Atheroembolism, Fat embolism

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Atheromatous disease of the thoracic aorta: pathologic and clinical implications

Article Abstract:

Atherosclerotic plaques in the aorta may break off to block blood vessels. A new imaging technique, transesophageal echocardiography, allows visualization of atherosclerotic plaques in the aorta. Larger plaques have been shown to be associated with blood vessel blockages, including strokes. Manipulations of the aorta during catheterization, balloon-pump angioplasty, and cannula placement during heart surgery may break the plaque loose. Alterations in procedure should help avoid this complication. Anticlotting medication may help prevent emboli. Surgical removal may be considered. Transesophageal echocardiography should be considered in persons experiencing emboli of unknown cause.

Care and treatment, Atherosclerosis, Arterial occlusions, Arterial occlusive diseases

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