Diagnosis by ultrasound of severe carotid artery disease in patients undergoing cardiopulmonary bypass operations.

Abstract

A non-invasive method using continuous wave Doppler shift ultrasound and spectral analysis was used as a screening test for severe carotid artery disease in patients undergoing cardiopulmonary bypass operations. One hundred and eighty-eight patients were examined before cardiac surgery (91 for ischaemic heart disease, 17 for ischaemic heart disease and valve replacement, 66 for valve replacement alone, and 14 for congenital abnormalities). The mean age of the 108 patients suffering from ischaemic heart disease was 54 years (±8) and that of the 80 patients admitted either for valve replacement alone or for congenital abnormalities was 52 years (± 12). Five of the 108 patients suffering from ischaemic heart disease were found to have severe occlusive disease of the internal carotid artery by the ultrasound test, while the test was normal in the other two groups. Patients with severe carotid artery disease proceeded to carotid arteriography and endarterectomy before the planned heart operation.

Clinical diagnosis by transcutaneous Doppler ultrasound

“…However, the accuracy of diagnosis of carotid artery disease by Doppler ultrasound has been questioned by a number of groups (Bone and Barnes, 1976; who found the ultrasound technique alone to be too insensitive to be relied upon and recommended that it be used in combination with oculoplethysmography and carotid phonoangiography. Lewis et al (1980a) have, however. found the Doppler technique ideal for the routine screening of patients for carotid artery disease before open heart surgery since the combination of occlusive disease and reduced blood pressure represents a potential for postoperative complications.…”