Related Experiment Videos
Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography
S Mohr-Kahaly1, R Erbel, H Rennollet
1II. Medical Clinic, Johannes Gutenberg University Mainz, FRG.
Insights
Transesophageal echocardiography effectively monitors aortic dissection, revealing persistent false lumens in most patients post-treatment. This advanced imaging is ideal for detecting and following aortic dissections.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Surgical Outcomes
Background:
- Aortic dissection is a life-threatening condition requiring accurate diagnosis and monitoring.
- Transesophageal echocardiography (TEE) offers advanced visualization of aortic pathology.
- Evaluating the long-term outcomes of aortic dissection management is crucial.
Purpose of the Study:
- To assess the efficacy of transesophageal echocardiography in the follow-up of aortic dissection patients.
- To characterize the persistence and morphology of the false lumen after surgical or medical therapy.
- To identify intimal tears and flow patterns within the dissected aorta.
Main Methods:
- Follow-up of 18 patients with aortic dissection (DeBakey types I, II, III) using transesophageal, two-dimensional, and color-coded Doppler echocardiography.
- Assessment of false lumen patency, thrombus formation, and intimal tear visualization.
- Analysis of flow patterns within the false lumen and across intimal tears.
Main Results:
- Persistent false lumens were observed in 71% after surgery and 82% after medical therapy.
- Thrombus formation varied, with progressive thrombus in 6 patients.
- TEE identified intimal tears in the descending aorta in 10 patients, with biphasic flow across tears in 75%.
Conclusions:
- Transesophageal echocardiography is superior to conventional methods for visualizing aortic dissection, especially in the descending aorta.
- TEE is an ideal method for the detection and follow-up of aortic dissection.
- The high rate of false lumen persistence highlights the need for ongoing monitoring.
Abstract:
Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas color-coded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20% from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal two-dimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up.