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Three-dimensional transesophageal echocardiographic evaluation of coronary involvement in patients with acute type A

Shunsuke Sasaki1, Hiroyuki Watanabe, Kentaro Shibayama

  • 1Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan. sasakish@gamma.ocn.ne.jp

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|June 14, 2013
PubMed

Insights

Three-dimensional transesophageal echocardiography (3D TEE) improves visualization of coronary ostia in patients with acute Stanford type A aortic dissection (AAD). This advanced imaging technique reduces diagnostic uncertainty compared to computed tomography and 2D TEE.

Area of Science:

  • Cardiovascular Imaging
  • Thoracic Surgery
  • Diagnostic Technology

Background:

  • Acute Stanford type A aortic dissection (AAD) presents a high mortality risk, particularly with coronary artery involvement.
  • Accurate visualization of coronary ostia is crucial but challenging with conventional computed tomography and 2D transesophageal echocardiography (TEE).

Purpose of the Study:

  • To evaluate the diagnostic accuracy of three-dimensional TEE (3D TEE) in detecting coronary ostia involvement in patients with AAD.
  • To compare the efficacy of 3D TEE against computed tomography and 2D TEE in identifying coronary artery abnormalities.

Main Methods:

  • Fifty-one patients with AAD underwent intraoperative TEE.
  • Coronary ostia status was assessed using computed tomography, 2D TEE, and 3D TEE, categorized by lumen origin or dissection.
  • Findings were compared with intraoperative surgical evaluations.

Main Results:

  • 3D TEE clearly identified coronary involvement in all six surgically confirmed cases.
  • While computed tomography and 2D TEE showed unclear results for 69 and 16 ostia respectively, 3D TEE clarified all but one of these cases.
  • 3D TEE significantly reduced the number of indeterminate coronary ostia assessments.

Conclusions:

  • Three-dimensional TEE enhances the evaluation of coronary ostia status in the operating room for AAD patients.
  • 3D TEE offers superior clarity in diagnosing coronary involvement compared to computed tomography and 2D TEE, aiding surgical decision-making.
Abstract

Keywords:
2D3DAADAcute Stanford type A aortic dissectionAortic dissectionCTComputed tomographyCoronary involvementIntraoperative transesophageal echocardiographyLCALeft coronary arteryRCARight coronary arteryTEETTEThree-dimensionalThree-dimensional transesophageal echocardiographyTransesophageal echocardiographyTransthoracic echocardiographyTwo-dimensional

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