901-108 Atheromatous Disease of the Thoracic Aorta: A Transesophageal Echocardiography and Autopsy Correlative Study

Transesophageal echocardiography (TEE) is widely used for the evaluation of thoracic aortic pathology, most recently atheromatous disease. Unfortunately, there have not been any studies correlating TEE and autopsy findings of atheroma to validate this use of the technique. Also, the TEE grading systems for aortic atheromatous disease currently in use have not been established to parallel pathologic grading systems, nor has their clinical significance been tested.We retrospectively evaluated all patients who underwent TEE at our institution between 1988 and 1993 and subsequently underwent autopsy within 30 days of the TEE study. We identified 13 patients with adequate thoracic aortic tissue available for pathologic analysis who also had a complete TEE examination of either the ascending, arch or descending thoracic aortic segments. Among these there were 21 complete tissue segments available which had been adequately imaged. All segments were reviewed and compared with respect to: (1) surface area and pattern of atheroma, (2) area and pattern of calcification, (3) depth of mural ulceration, and (4) type and description of mural thrombus; also (5) measurements of maximum wall thickness, (6) sizing of any aneurysm, and (7) characterization of any dissection.Significant correlations were found using this detailed grading system for surface area of atheroma (kappa test, k=0.29±0.26), wall thickness (correlation, r=0.56). correct identification of the one ascending aortic aneurysm, and absence of dissection or mural thrombus. The correlations for pattern of atheroma, area and pattern of calcification and depth of ulceration did not reach statistical significance. However, there was an 86 to 100% agreement for these lesion characteristics when allowing for 1 category of variation.ConclusionsThere is a good correlation between TEE and autopsy findings with respect to: (1) atheroma surface area, (2) aortic wall thickness, and (3) the identification of aortic aneurysm, TEE and autopsy grading of lesion characteristics have excellent agreement when allowing for one category of variation. The clinical relevance of this grading system requires further study