Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography

Iliceto, Sabino; Ettorre, Giovanni Carlo; Francioso, G; Antonelli, G; Biasco, G; Rizzon, Paolo

doi:10.1093/oxfordjournals.eurheartj.a061704

Cited by 51 publications

(18 citation statements)

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“…As has been described in previous angiographic,42 echocardiographic, [20][21][22] and computed tomographic43,44 studies after surgery or medical therapy, a persistence of the false lumen was found in 78% of the patients in whom the false lumen had not been completely resected during surgery. Furthermore, a persistence of flow within the false lumen was shown in all of these patients.…”

Section: Complicationssupporting

confidence: 61%

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

et al. 1989

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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

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Section: Complicationssupporting

confidence: 61%

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

et al. 1989

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“…The TEE technique with color Doppler imaging has higher diagnostic reliability than YFE6 9,26,27; TEE avoids inherent limitations of the transthoracic approach such as obesity, narrow intercostal spaces, pulmonary emphysema, and mechanical ventilation by allowing the thoracic aorta to be scanned in multiple sections from close vicinity. '6,28 Moreover, the feasibility of TEE in the setting of aortic dissection and its superiority to conventional radiographic techniques have been demonstrated.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

et al. 1992

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BACKGROUND Aortic dissection requires prompt and reliable diagnosis to reduce the high mortality. The purpose of this study was to assess the reliability of both ECG-triggered magnetic resonance imaging (MRI) and transesophageal two-dimensional echocardiography combined with color-coded Doppler flow imaging (TEE) for the diagnosis of thoracic aortic dissection and associated epiphenomena. METHODS AND RESULTS Fifty-three consecutive patients with clinically suspected aortic dissection were subjected to a dual noninvasive imaging protocol in random order; imaging results were compared and validated against the independent morphological "gold standard" of intraoperative findings (n = 27), necropsy (n = 7), and/or contrast angiography (n = 53). No serious side effects were encountered with either imaging method. In contrast to a precursory screening transthoracic echogram, the sensitivities of both MRI and TEE were 100% for detecting a dissection of the thoracic aorta irrespective of its location. The specificity of TEE, however, was lower than the specificity of MRI for a dissection (TEE, 68.2% versus MRI, 100%; p less than 0.005), which resulted mainly from false-positive TEE findings confined to the ascending segment of the aorta (TEE, 78.8% versus MRI, 100%; p less than 0.01). In addition, MRI proved to be more sensitive than TEE in detecting the formation of thrombus in the false lumen of both the aortic arch (p less than 0.01) and the descending segment of the aorta (p less than 0.05). There were no discrepancies between the two imaging techniques in detecting the site of entry to a dissection, aortic regurgitation, or pericardial effusion. CONCLUSIONS Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta. TEE, however, is associated with lower specificity for lesions in the ascending aorta. These results may still favor TEE as a semi-invasive diagnostic procedure after a precursory screening transthoracic echogram in suspected aortic dissection, but they establish MRI as an excellent method to avoid false-positive findings. Anatomic mapping by MRI may emerge as the most comprehensive approach and morphological standard to guide surgical interventions.

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“…The visualization of an intimal flap that separates the true and false lumens within the aorta is pathognomonic of aortic dissection [66] as shown in Figure 4 and Figure 5. The two-dimensional echocardiography appears to be superior [67] There are 3 types of intimal flap were identified as shown in Table 5.…”

Section: Echocardiographic Featuresmentioning

confidence: 99%

Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

Muthiah¹

2017

CRCM

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Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.

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Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography

Cited by 51 publications

References 0 publications

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

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

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

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