The aim of this study was to evaluate the atherosclerotic changes of the entire thoracic aorta using transesophageal echocardiography (TEE) as well as epiaorta echography (epiaorta echo) in CABG surgical patients and to evaluate specifically the use of epiaorta echo. A total of 230 consecutive patients were studied (201 TEE, and 29 both TEE and epiaorta echo examinations). Intra-aortic plaque was detected by 70.0 +/- 8.5 years, while that of 73 patients without plaque was 54.5 +/- 9.2 years. The difference was statistically significant (P < 0.001). The plaque was detected as solitary or diffused. By TEE, it was impossible to obtain images from the distal ascending aorta to the proximal aortic arch (blind zone). By epiaorta echo, clear images from the aortic valve annulus to the first 3 cm of proximal ascending aorta was difficult to obtain. However, the rest of the ascending aorta to the proximal arch was clearly imaged. Thus, when TEE demonstrates diffused plaque in the aortic annulus to the proximal ascending aorta, epiaorta echo should be used to examine the distal ascending aorta to the proximal arch.