Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Abstract

Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas colorcoded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20%o from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the aorta (two of 18 patients), mediastinal hematoma (one of 18 patients), or aortic regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal twodimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up. (Circulation 1989;80:24-33 Transesophageal echocardiography overcomes these methodologic limitations and is of great diagnostic value because of high-quality cross-sectional images of the ascending and descending thoracic aorta even in patients in shock or on mechanical ventilation.23-30 Surgery without further diagnostic investigation has been performed successfully in emergency cases.30 In combination with color-coded Doppler flow imaging, which superimposes flow information

Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography.

“…In the case of medical therapy, confirmation of the diagnosis by one additional diagnostic method (computed tomography, magnetic resonance imaging, or angiography) was necessary.11 Dissection was defined as acute when the diagnosis was made within 14 days of the onset of symptoms.…”

“…In addition to two-dimensional echocardiography, color Doppler flow imaging was used and superimposed and imaged as previously described. 14 Images were stored on video tape and hard copies. Together with patient data, they were collected at the coordinating center in Mainz.…”

“…9 The sensitivity and specificity of transesophageal echocardiography for the diagnosis of aortic dissection are 99% and 88%, respectively, compared with 83% and 100% for computed tomography and 88% and 94% for angiography. 10 Transesophageal echocardiography allows not only visualization of the intimal flaps and intimal tears but also differentiation of true and false lumens and detection of complications.10-13 Transesophageal echocardiography appears to be ideally suited for follow-up studies12, 14 because it makes it possible to detect and locate intimal tears, which seem to be the major determinants of dissection healing and cause of death. 15 See p 1765…”

Aortic Dissection: New Frontiers in Diagnosis and Management

“…With diminishing false lumen flow, thrombus formation may take place, heralded by spontaneous contrast. 6,81,82 Conversely, noncommunicating aortic dissections cannot always be differentiated from IMH; an acute symptomatology may speak for IMH potentially progressing to full dissection with typical appearance. 41,42,46,59 In presence of false lumen flow, the exact location of entries may be instrumental in choosing potential treatment options.…”

Usefulness of transesophageal echocardiography in assessment of aortic dissection.

“…Two-dimensional echocardiography15-22 has recently been used in the diagnosis of this entity, but the sensitivity and specificity of this technique in the diagnosis of acute dissection have not been high due to limitations in obtaining adequate images with poor acoustic windows in patients with obesity, emphysema, or chest wall deformity and those on mechanical ventilation. 23 Transesophageal color Doppler echocardiography is a relatively new and safe technology with exciting potential in the evaluation of this life-threatening disorder. [24][25][26][27][28] The major advantage of transesophageal echocardiography is the ability to image almost the entire thoracic aorta with no acoustic window impedance.…”