[Intraoperative assessment of the ascending aorta by echogram during the CABG operation for the prevention of cerebral infarction].

While coronary artery bypass grafting operations (CABG), we started to use the echogram to evaluate the ascending aorta intraoperatively from December 1993. During a period from January, 1990, to June, 1995, 379 patients were treated with CABG. Intraoperative echogram was used in 127 cases (group I) and 252 cases unused (group II). The sites of the aorta for evaluation were following: site of cannulation, aortic clamping, and proximal anastomosis respectively. Depending on the echographical findings the operative procedures were changed as required. The incidence of postoperative cerebral embolism in group I was 0.8% (one patient) and in group II, 2.4% (6 patients). Although no significant difference was found in the cohort, rate of incidence in the group II was high. There were 4 cases who had significant atheromatous lesions clearly evaluated by echogram, which were not detected by palpation. We conclude that the intraoperative assessment of the ascending aorta by echogram is beneficial in prevention of cerebral infarction.

[Preoperative assessment of aortic dissection by three-dimensional CT angiography].

In 21 patients with aortic dissection including 12 patients with acute aortic dissection, aortic lesions were evaluated preoperatively by newly developed three-dimensional CT angiography (3 D-CTA) using helical scan CT. Rapid and safe three-dimensional evaluation of aortic dissection was achieved with no complications. Three-dimensional structure of aortic dissection was well reflected in the image of 3D-CTA. Preoperative three-dimensional evaluation was useful to determine and proceed the operative procedure for the repair of aortic dissection. All patients were alive and results of surgical treatments were excellent. Intimal flaps and entries were visualized by multiple threshold display (MTD) method of 3D-CTA. Multiple threshold display method is an important three-dimensional reconstructive method and 3D-CTA may be a new useful and powerful diagnostic modality for aortic dissection.

Assessment of aortic disease using three-dimensional CT angiography.

The recently developed technique of three-dimensional CT angiography (3D-CTA) was applied to 68 patients with aortic disease. These patients were examined using a unique method of data collection: a helical scanner with continuous tube rotation and continuous table feed. The scanner was used in conjunction with administration of dynamic intravenous contrast material to enhance the vascular image. The group of patients included 35 with aortic dissection, 19 with true thoracic aneurysms, and 14 with abdominal aortic aneurysms. Three-dimensional evaluation was achieved in all patients with no complications. Surgical intervention was used in 45 patients with aortic dissections and aortic aneurysms, and 44 of these patients (98%) survived and were discharged. Preoperative 3D-CTA findings were quite similar to intraoperative findings, and were useful in determining operative procedures. Rapid and accurate assessment of aortic disease was achieved by 3D-CTA. Three-dimensional CT angiography can play an important role in the preoperative assessment of aortic dissections and aortic aneurysms leading to successful surgical treatment.