Rapid Diagnosis and Management of Thoracic Aortic Dissection and Intramural Haematoma: a Prospective Study of Advantages of Multiplane vs. Biplane Transoesophageal Echocardiography

Abstract

Aims:The purposes of this study were to compare the accuracy of multiplane vs. biplane transoesophageal echocardiography (TEE) in the diagnosis of aortic dissection and aortic intramural haematoma, and to test whether these techniques provide all the diagnostic information required to make management decisions. Methods and Results:Fifty-eight consecutive patients with clinically suspected aortic dissection were studied with multiplane TEE; all cases who required surgery underwent intraoperative monitoring with multiplane TEE.The following multiplane TEE data were analysed: the angle between current and 0 plane at which each view was obtained; the success rate in the evaluation of true and false lumen, entry tear, coronary artery involvement, aortic regurgitation, pericardial effusion. Advantages of multiplane over biplane TEE have been evaluated by the demonstration of usefulness of views obtained in planes other than 0 -20 or 70 -110 , assuming that with manipulation of a biplane probe a 20 arc could be added to the conventional horizontal and vertical planes.On the basis of TEE findings, aortic dissection was confirmed in 36 cases (18 type A, 12 type B, six intramural haematoma). The specificity and sensitivity of TEE in terms of the presence or absence of aortic dissection or intramural haematoma were 100%. An additional clinical value of multiplane over biplane TEE in the evaluation of ascending aorta, aortic arch, entry tears and coronary artery involvement was demonstrated. All cases with type A aortic dissection or intramural haematoma involving the ascending aorta had an operation that was performed immediately after the diagnosis (hospital mortality, 13%). Patients with type B aortic dissection were treated medically; 25% of these cases were operated later (hospital mortality, 0%). Conclusions:Multiplane and biplane TEE have excellent and similar accuracies in the evaluation of aortic dissection and intramural haematoma. Multiplane TEE improves the visualization of coronary arteries, aortic arch and entry tears; it appears to be an ideal method as the sole diagnostic approach before surgery in type A aortic dissection.

Diretrizes para a cirurgia das doenças da aorta

“…De modo geral, pode-se considerá-lo uma condição tão potencialmente catastrófica quanto a DAA e inferir que a mortalidade seja significativa -20 a 80% [114][115][116] , que a evolução para dissecção verdadeira deva ocorrer em 15 a 41% dos casos [117][118][119][120] , a ruptura em 5 a 26% dos pacientes, e a evolução para cura espontânea, de forma variável 121,122 . Em um levantamento prospectivo recente de 360 casos de dissecções aórticas agudas, Nienaber e cols.…”

Diretrizes para o tratamento cirúrgico das doenças da aorta da Sociedade Brasileira de Cirurgia Cardiovascular

“…Generally, this can be considered a condition as potentially catastrophic as acute aortic dissections inferring that the mortality rate is significant -from 20 to 80% [110][111][112]; the evolution to true dissections occurs in 15 of 41% of the cases [112][113][114][115][116], to ruptures in 5% to 26% of the patients and evolution to spontaneous cure varies [117,118]. In a recent study of 360 cases of acute aortic dissections, Nienaber et al [113] observed that 25 (12%) cases presented evident false lumen, but without identified intimal injury in the diagnostic examinations.…”

The utility of multiple imaging modalities to diagnose acute aortic dissection

“…Recent studies suggest that less invasive studies such as TEE, CT scanning and MRI provide excellent diagnostic accuracy and mitigate some of the risks inherent to retrograde angiography (Table 2). [7][8][9][10][11][12][13][14][15][16][17][18][19] Unfortunately, the methodology of the research studies supporting the use of these alternative imaging modalities may make their results inappropriate for populations with a relatively low prevalence of aortic dissection.…”