Transesophageal echocardiography for the diagnosis of thoracic aorta aneurysms and dissections

The diagnosis of acute aortic pathology is decisive for the prognosis of the patient, since an effective surgical and medical therapy can improve the high rate of mortality due to this pathology. Conventional transthoracic echocardiography (TTE) fails to detect abnormalities of the descending thoracic aorta. Aim of this study was the evaluation of the actual usefulness of transesophageal echocardiography (TEE) in the diagnosis of aneurysm (AN) and/or dissection (DISS) of the aorta. Fifty-six consecutive patients with clinical suspicion of AN or DISS underwent TEE. Of these, 24 (42.8%) did not show any abnormality, while 32 (57.2%) had a severe pathology of the aorta requiring angiography (ANG) or cardiac surgery (SURG). All the patients underwent computed tomography scanning examinations (CT) even if TEE did not show any abnormality. The diagnoses obtained by TTE, TEE and CT were compared with those obtained by reference methods (ANG and/or SURG). Non-dissecting aorta aneurysms were detected in 11 patients; dissecting aorta aneurysms were found in 21 patients; 5 patients showed an isolated aortic dissection (without aneurysm). The sensitivity of TTE for detecting pathology of the aorta resulted very low (56.3%) when compared to TEE (96.8%) and CT (90.6%). The specificity for diagnosing aortic pathology was for TTE 63.1%, for TEE 96.0% and CT 88.8%; the accuracy of TTE resulted 75.0%, TEE 98.2% and CT 94.6%; the predictive value of TTE was 85.7%, TEE 96.8% and CT 93.5%. In conclusion, TEE provides a reliable non-invasive diagnosis of AN and/or DISS superior to TTE and CT; it may be considered the method of choice to detect acute aorta pathology.