Transesophageal echocardiography (TEE) was performed on a 73-year-old man with a history of hypertension, hypertensive heart disease, and atrial fibrillation, before he underwent cardioversion for atrial fibrillation. Aortic views showed diffuse atherosclerosis of the aorta with a large, nonhomogeneous, sessile grade-4 atheroma in the proximal descending thoracic aorta. The atheromatous mass was protruding 14 mm into the aortic lumen, obliterating more than half of the aorta (Fig. 1).
Fig. 1 Transesophageal echocardiographic view of the proximal descending thoracic aorta in the longitudinal plane shows a large, nonhomogeneous, sessile grade-4 atheroma (A) protruding 14 mm into the aortic lumen (L).
Similarly, TEE was performed on an 81-year-old man before he underwent cardioversion for atrial fibrillation. Aortic views showed a large grade-5 atheroma in the proximal descending thoracic aorta, protruding 11 mm into the aortic lumen. The distal part of the atheroma was freely mobile and was attached to the main atheromatous mass by a narrow stalk (Fig. 2).
Fig. 2 Transesophageal echocardiographic view of the proximal descending thoracic aorta in the horizontal plane shows a large grade-5 atheroma (A) protruding 11 mm into the aortic lumen (L). The distal part of the atheroma was freely mobile and was attached to the main atheromatous mass by a narrow stalk.
Real-time motion image is available at texasheartinstitute.org/siddi291.html.
Atherosclerotic lesions of the thoracic aorta have recently been recognized as one of the major sources of peripheral embolism. 1 Aortic atheromas are classified on the basis of their thickness and mobility. Grade 1 is an aortic wall intima with no or minimal thickening; grade 2, extensive aortic wall intimal thickening but no protruding atheroma; grade 3, sessile atheroma protruding less than 5 mm into the aortic lumen; grade 4, sessile atheroma protruding at least 5 mm into the aortic lumen; and grade 5, mobile protruding atheroma. The risk of development of thromboemboli is related to the thickness and anatomic structure of the atheroma. 2,3 The presence of mobile components or ulceration and the absence of calcification in the atheroma are also associated with a higher risk of thromboembolism. 4,5 Transesophageal echocardiography is the procedure of choice for the evaluation and diagnosis of aortic atherosclerosis. 6,7
Supplementary Material
Footnotes
Address for reprints: Ijaz A. Khan, MD, Creighton University Cardiac Center, 3006 Webster Street, Omaha, NE 68131-2044
Web site: This article has also been published on the THI Web site at texasheartinstitute.org/siddi291.html
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