Assessing the aorta with transesophageal echocardiography. Update on imaging capabilities with today's technology

Improved ultrasound imaging with transesophageal echocardiography is now readily available, so prompt, portable, convenient, and safe assessment of aortic disease is possible. The procedure offers a diagnostic approach that may be more useful and less expensive than other imaging studies. Many experts recommend transesophageal echocardiography as the procedure of choice in patients with possible aortic dissection, especially those who are in clinically unstable condition. Most patients can successfully undergo transesophageal echocardiography. The procedure is also an excellent method for evaluating the success of surgical repair of aortic dissection, and it can be used in long-term patient follow-up. Transesophageal echocardiography can assess atherosclerotic lesion size and composition, the dynamic effect of flow, and the aortic intima and lumen in evaluation of aortogenic embolization. It may help identify patients at high risk of stroke during cardiac surgery. In addition, the procedure is sensitive and specific in diagnosing penetrating aortic ulcers, which occur when an atheromatous lesion pierces the internal elastica and extends into the aortic wall media. The process may cause formation of intramural hematoma, identified on transesophageal echocardiography as homogeneous mottled thickening of the aortic wall and inward displacement of intimal calcification.