**1. Introduction**

34 Echocardiography – In Specific Diseases

[39] Ng AC, Delgado V, Bertini M, Antoni ML, van Bommel RJ, van Rijnsoever EP, van der

speckle tracking analysis. Eur Heart J 2011; 32: 1542-50.

Kley F, Ewe SH, Witkowski T, Auger D, Nucifora G, Schuijf JD, Poldermans D, Leung DY, Schalij MJ, Bax JJ. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional

> A considerable burden of cerebral embolism in association with cardiac surgery reflects dislodgement of aortic atheroma caused by manipulating the aorta during a surgical procedure (Barbut and Gold 1996; Van Zaane, Zuithoff et al. 2008; Whitley and Glas 2008; Yamaguchi, Adachi et al. 2009). It clearly makes logical sense to identify and attempt to avoid dislodgement of aortic atheroma. This strategy depends on two key elements; the accurate detection of atheroma in the aorta, and the surgeons ability to avoid or otherwise minimise manipulation of atheromatous disease.

> In this chapter we will describe how epiaortic echocardiography is essential to the complete examination of the ascending aorta and aortic arch for the detection of atheroma, and what surgical options may be available for the avoidance or minimisation of aortic atheroma manipulation.
