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Echo-of-the-Day Information
The Echo-of-the-Day is a presentation of 1 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

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Loop Text Key  
Preop Preop TEE or TTE
Intraop An Intraop TEE
IntraopPreOp Intraop TEE or TTE before Operation
IntraopPostOp Intraop TEE or TTE after Operation
IntraopEnd Intraop TEE or TTE at End of Anesthesia
Post Op Postop TEE or TTE
Echo of the Day Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Ascending Aorta
Case#: 37
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
A patient scheduled for a CABG w/ECC w/EVH has the following loop:
Case Discussion
The echocardiographic findings are a PAC in the right pulmonary artery, a linear artifact that is a mirror artifact from the PAC in the ascending aorta (although this wold have to be confirmed that it is not an aortic flap), and an irregular endocardial border of the ascending aorta .  The irregular endocardium is atherosclerosis that is protruding and immobile.  The protruding plaque is about 1 cm in length.

The classification of this atherosclerosis is a grade 4 lesion.  A grade 4 lesion indicates that the risk of stroke is about 11%.

Because of the risk of stroke the ascending aorta should not be cannulated or cross clamped.  Also, SVG should be placed by a punch technique rather than a partial cross clamp.  An epiaortic scan should be performed to identify other areas of significant atherosclerosis.  Depending upon the epiaortic scan, an ascending aortic replacement should be considered.

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