Epiaortic ultrasonography can accurately differentiate a protruding coronary stent from severe atheromatous calcification, potentially avoiding unnecessary surgical interventions like aortotomy.
May clarify ambiguous TEE ostial masses as stents; leaves open whether routine epiaortic use changes management.
A 76-year-old male patient was admitted for mitral valvuloplasty. He had suffered a myocardial infarction 7 months earlier, and two stents had been inserted in the left main coronary artery and left circumflex artery. Intraoperative transesophageal echocardiography revealed a 10 × 8 mm echogenic mass at the ostium of the left main coronary artery. We initially suspected severe atheromatous calcification at the coronary ostium, which might require aortotomy and removal, but we decided to perform an epiaortic ultrasonographic scan first to obtain better images and reevaluate. Epiaortic scanning with a linear sonographic probe identified the mass as a protruding coronary stent.
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Kim et al. (2014) studied this question.
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