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[Transesophageal Doppler echocardiography in the diagnosis of dissecting aortic aneurysm]
S Hashimoto1, T Kumada, S Kubo
1Department of Internal Medicine, Kyoto University.
Insights
Transesophageal Doppler echocardiography (TEDE) effectively diagnoses aortic dissection by visualizing intimal flaps and blood flow. This reliable imaging technique aids in identifying complex aortic aneurysms.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Echocardiography
Background:
- Aortic dissection is a life-threatening condition requiring accurate diagnosis.
- Conventional imaging methods may have limitations in diagnosing aortic dissection.
Observation:
- Transesophageal Doppler echocardiography (TEDE) was utilized in three patients with DeBakey type I and III aortic dissections.
- TEDE provided clear visualization of dissected aortas, intimal flaps, entry/reentry sites, and artificial grafts post-surgery.
- In one case, TEDE successfully diagnosed aortic dissection when other imaging modalities failed.
Findings:
- TEDE accurately identified intimal flap defects and pulsatile flow into the false lumen.
- The technique clearly delineated artificial grafts and aortic boundaries in post-operative patients.
- Color Doppler imaging demonstrated abnormal flow patterns indicative of dissection.
Implications:
- TEDE is a valuable and reliable tool for diagnosing aortic dissection.
- This imaging modality can aid in surgical planning and post-operative assessment.
- TEDE offers diagnostic capabilities when other imaging techniques are inconclusive.
Abstract:
Transesophageal Doppler echocardiography (TEDE) was performed in three patients with proven or suspected DeBakey type I and type III aortic dissection. Case 1: A 66-year-old woman, with DeBakey type I aortic dissection. Clear images of a widened dissected aorta and an intimal flap were obtained in both the ascending and descending aorta, including the aortic arch. The site of an entry into the false lumen was identified by the defect of the intimal flap and the pulsatile entry flow through it. The reentry into the true lumen was also identified near the orifice of the celiac trunk. In this case, the observation was performed using this technique during the operation; i.e., replacement of the ascending aorta with an artificial graft. Case 2: A 77-year-old man, DeBakey type III aortic dissection. The study was performed after surgery which consisted of replacement of the descending aorta with an artificial graft. TEDE provided clear images of the artificial graft, the aorta, and their boundaries. The remaining intimal flap was clearly confirmed. Case 3: An 80-year-old man, DeBakey type III aortic dissection. In this case, though abdominal echography suggested aortic dissection, angiography and X-ray CT failed to facilitate the diagnosis. Only TEDE confirmed the diagnosis. The abnormal flow via the entry directing toward the false lumen was clearly demonstrated on the color Doppler images. We therefore conclude that TEDE is a useful and reliable means of diagnosing dissecting aortic aneurysm.