Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein, Steven A.; Evangelista, Arturo; Abbara, Suhny; Arai, Andrew E.; Asch, Federico M.; Badano, Luigi P.; Bolen, Michael A.; Connolly, Heidi M.; Cuéllar-Calàbria, Hug; Czerny, Martin; Devereux, Richard B.; Erbel, Raimund; Fattori, Rossella; Isselbacher, Eric M.; Lindsay, Joseph; McCulloch, Marti; Michelena, Héctor I.; Nienaber, Christoph; Oh, Jae K.; Pepi, Mauro; Taylor, Allen J.; Weinsaft, Jonathan W.; Zamorano, José Luís; Dietz, Harry C.; Eagle, Kim A.; Elefteriades, John A.; Jondeau, Guillaume; Rousseau, Hervé; Schepens, Marc A.A.M.

doi:10.1016/j.echo.2014.11.015

Cited by 507 publications

(440 citation statements)

References 428 publications

(517 reference statements)

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“…51 • Measurement of the aortic root and ascending aorta in the 2-dimensional (2D) mode at four levels: annulus, sinuses of Valsalva, sinotubular junction and tubular ascending aorta. 52 Measurements are taken in the parasternal long-axis view from leading edge to leading edge at end diastole, except for the aortic annulus, which is measured in mid systole. As it will have surgical consequences, it is important to differentiate three phenotypes of the ascending aorta: aortic root aneurysms (sinuses of Valsalva >45 mm), tubular ascending aneurysm (sinuses of Valsalva <40-45 mm) and isolated aortic regurgitation (all diameters <40 mm).…”

Section: Iib Cmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

596

921

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Section: Iib Cmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

596

921

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“…Sometimes an intimal flap or tear at the proximal ascending aorta is not shown on enhanced CT, as in our case 3. Thus, it is difficult to distinguish a real flap and tear from an artefact 7. Electrocardiographically gated CT angiography is recommended to reduce aortic pulsation artefacts 7.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is difficult to distinguish a real flap and tear from an artefact 7. Electrocardiographically gated CT angiography is recommended to reduce aortic pulsation artefacts 7. Transthoracic echocardiography and transesophageal echocardiography (TEE) should be used to screen for aortic dissection even if type B aortic dissection is diagnosed with CT 7…”

Section: Discussionmentioning

confidence: 99%

A case of circumferential type A aortic dissection with intimal intussusception diagnosed using repeat transthoracic echocardiography examination

Yamagishi

Kashiura

Nakata

et al. 2017

Acute Medicine & Surgery

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CaseSometimes it is difficult to diagnose circumferential aortic dissection with enhanced computed tomography alone. A 58‐year‐old woman presented with sudden‐onset chest discomfort and loss of consciousness. Transthoracic echocardiogram showed mild aortic regurgitation. Enhanced computed tomography scans showed no obvious intimal tear or flap at the proximal ascending aorta, but an intimal flap was observed from the aortic arch to both common iliac arteries. Stanford type B dissection was tentatively diagnosed. Repeat detailed transthoracic echocardiography examination showed an intimal tear and flap at the ascending aorta; prolapse into the left ventricle caused severe aortic regurgitation. Type A aortic dissection was definitively diagnosed; emergent operation showed a circumferential intimal tear originating from the ascending aorta.OutcomeThe ascending aorta was replaced; aortic regurgitation disappeared. The patient was discharged in a good condition 58 days postoperatively.ConclusionDynamic evaluations with transthoracic echocardiography should be carried out to diagnose circumferential aortic dissection.

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“…The ESC Grown Up Congenital Heart Disease Guidelines suggest this be done on a five-yearly basis [33]. More recent ESC and AHA multimodality imaging guidelines suggest a three-yearly interval, but this statement is unreferenced in the document [34]. If relatively frequent serial imaging is to be undertaken, MRA may be preferable to CTA in order to minimise the risks associated with recurrent radiation exposure.…”

Section: Surveillance For Aortic Dilatation a Usual Practice Is Clinmentioning

confidence: 99%

“…Imaging guidelines highlight the concerns that indexation consistently allows a greater aortic size in larger individuals [34]. In contrast, surgical thresholds, other than for women with TS, are all expressed as absolute values.…”

mentioning

confidence: 99%

Update on the Diagnosis and Management of Inherited Aortopathies, Including Marfan Syndrome

Zentner

West

Adès

2017

Heart, Lung and Circulation

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Key Points1. A number of inherited conditions can predispose the aorta, and less commonly other blood vessels, to dilatation and/ or rupture.2. Broadly speaking, these conditions are recognised as syndromic when accompanied by a number of systemic features or non-syndromic when the aortic dilatation appears to exist in isolation.3. The commonest syndromic aortopathy is Marfan syndrome and the commonest nonsyndromic aortopathy is that which accompanies congenital bicuspid aortic valve.4. Mutations in a number of genes have been identified, particularly in syndromic aortopathy.5. Although genotype-phenotype relationships exist, the phenotypes of the syndromic aortopathies may have significant overlap .6. When a syndromic aortopathy is suspected, review by a clinical geneticist is instrumental in characterising the clinical signs and the family history.7. Confirmation of a diagnosis (either clinically or by gene testing) allows identification of individuals at increased risk of aortic sequelae who will benefit from active medical management.8. Medical management is usually undertaken by a cardiologist with referral to other specialists (eg cardiothoracic surgeons) as appropriate.9. At risk family members should be offered predictive testing if a mutation is identified, and should otherwise be screened in keeping with the presumptive clinical diagnosis and assessment of risk.10. Pregnancy and the post-partum period confer a higher risk for aortic complications: a. Women with a personal or family history of aortopathy need appropriate preconception screening and counseling.b. Intervention may be required pre-conception and they should be managed closely throughout pregnancy, ideally in a high-risk obstetric clinic. A c c e p t e d M a n u s c r i p t 3 pregnancy, beta blockers can be used in pregnancy) and should include involvement of a cardiologist in the management and decision making for delivery.11. A clinical diagnosis of an inherited aortopathy can be made in the absence of a positive genetic test if the systemic features are consistent with a specific syndromic aortopathy. A familial history of aortic dissection in the absence of both a positive gene test and systemic examination findings may be more difficult to manage without a working clinical diagnosis. However, an inherited risk of dissection should nonetheless be considered in this setting, particularly if the process has affected young individuals and/or in the absence of traditional risk factors.

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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Cited by 507 publications

References 428 publications

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

A case of circumferential type A aortic dissection with intimal intussusception diagnosed using repeat transthoracic echocardiography examination

Update on the Diagnosis and Management of Inherited Aortopathies, Including Marfan Syndrome

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