Role of transesophageal echocardiography in surgical treatment of aortic dissection

Abstract

Acute type A aortic dissection is a life-threatening condition frequently complicated by rupture and/or malperfusion, which can occur at any time. While computed tomography (CT) is the gold standard for preoperative diagnostic imaging to develop the optimal surgical strategy, transesophageal echocardiography (TEE) is invaluable in the operating room. TEE compensates for the limitations of CT by providing real-time information, enabling timely and accurate management of unexpected events such as rupture, perfusion-related dissection, or new malperfusion in the coronary, cerebral, and visceral arteries. These critical events, often occurring out of sight of the surgical field, can go unrecognized by surgeons, anesthesiologists, or perfusionists. TEE acts as a navigational radar in an airport control tower, guiding experienced pilots through complex situations. However, the effectiveness of TEE depends on the operator’s ability to use it at the optimal timing and target the correct anatomical structures. This chapter aims to elucidate the methodology, timing, and specific assessments required for TEE to optimize intraoperative management of aortic dissection, ensuring the best possible outcomes for patients.