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Detection of aortic dissection by transoesophageal echocardiography
Insights
Combining transoesophageal and transthoracic echocardiography accurately diagnoses aortic dissection. This bedside imaging improves recognition of the condition, aiding treatment decisions.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Medicine
- Thoracic Surgery
Background:
- Aortic dissection is a life-threatening condition requiring accurate diagnosis.
- Conventional imaging methods like computed tomography and aortography have limitations in diagnosing aortic dissection.
- Echocardiography offers a non-invasive approach to visualize the aorta.
Purpose of the Study:
- To evaluate the diagnostic value of combined transoesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) for aortic dissection.
- To compare the diagnostic accuracy of combined echocardiography with computed tomography and aortography.
- To assess the ability of echocardiography to identify dissection types and intimal flaps.
Main Methods:
- Prospective evaluation of 21 patients with suspected aortic dissection.
- Utilized both transthoracic echocardiography and transoesophageal echocardiography.
- Results were compared with computed tomography, aortography, and surgical or necropsy findings.
Main Results:
- Transthoracic echocardiography alone had limited sensitivity for different dissection types.
- Combined TEE and TTE correctly identified the degree of aortic dissection in all 21 patients.
- Spontaneous echocardiographic contrast and mural thrombus were detected in some cases.
- Computed tomography and aortography showed limitations in detecting intimal flaps and diagnosing dissections.
Conclusions:
- The combination of TEE and TTE provides comprehensive imaging of the thoracic aorta.
- Adding TEE to TTE significantly improves the recognition and diagnosis of aortic dissection.
- This combined echocardiographic approach is a valuable bedside tool for guiding patient treatment.
Abstract:
The diagnostic value of a combination of transoesophageal and transthoracic echocardiography was evaluated in 21 patients with dissection of the aorta. The results were compared with those of computed tomography, aortography, and with findings at operation or necropsy or both. Transthoracic echocardiography identified three of the four patients with type I dissection, two of the five patients with type II dissection, and one of the 12 patients with type III dissection. When transoesophageal echocardiography was used as well the degree of aortic dissection was identified correctly in all 21 patients. In one patient with type I and in eight patients with type III dissection spontaneous echocardiographic contrast with a mural thrombus within the false lumen could be detected. Computed tomography was unable to demonstrate an intimal flap in one of two patients studied with type I dissection, in two of three patients with type II dissection, and in one of nine patients with type III dissection. Aortography was negative in one of two patients studied with type I dissection, two of four patients with type II dissection, and in one of eight patients with type II dissection. The whole thoracic aorta can be imaged by a combination of transthoracic and transoesophageal echocardiography. The addition of transoesophageal echocardiography to transthoracic echocardiography improves the recognition of aortic dissection. Furthermore, this examination can be performed at the bedside and the findings can be used as a basis for treatment.