Abstract
An ideal imaging technique should be able to confirm the diagnosis of aortic disease, classify the nature of aortic pathology [classic dissection versus intramural hematoma (IMH)], define the extent of aortic involvement (ascending, arch, and descending), and evaluate for associated complications. The diagnostic test should be sensitive, specific, and highly accurate. Diagnostic testing should be readily available to be done as quickly as possible considering the early high mortality of acute aortic disease (1% per hour in the first 48 h). It should also be able to provide additional information, which impacts the patient’s immediate management and long-term outcome such as myocardial ischemia, aortic valve (AV) regurgitation, cardiac tamponade, reentry tears, and aortic branch vessel involvement.
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References
Victor MR, Mintz GS, Kotler MN, Wilson AR, Segal BL. Two-dimensional echocardiographic diagnosis of aortic dissection. Am J Cardiol. 1981;48:1155–1159.
Mathew T, Nanda NC. Two-dimensional and Doppler echocardiographic evaluation of aortic aneurysm and dissection. Am J Cardiol. 1984;54: 379–385.
Khandheria BK, Tajik AJ, Taylor CL, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six year experience. J Am Soc Echocardiogr. 1989;2:17–25.
Granato JE, Dee P, Gibson RS. Utility of two-dimensional echocardiography in suspected ascending aortic dissection. Am J Cardiol. July 1, 1985;56(1): 123–129.
Evangelista A, Avegliano G, Elorz C, González-Alujas T, Garcia del Castillo H, Soler-Soler J. Transesophageal echocardiography in the diagnosis of acute aortic syndrome. J Card Surg. March–April 2002;17(2):95–106.
Chandrasekaran K, Currie PJ. Transesophageal echocardiography in aortic dissection. J Inv Card. 1989;1:328–338.
St John Sutton MG, Maniet AR. Diseases of the thoracic aorta. In: St John Sutton MG, Maniet AR, eds. Atlas of multiplane transesophageal echocardiography. 1st ed. NewYork: Taylor & Francis; 2003:333–468.
Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol. May 15, 2002;89(10):1235–1238.
Hashimoto S, Kumada T, Osakada G, et al. Assessment of transesophageal Doppler echography in dissecting aortic aneurysm. J Am Coll Cardiol. November 1, 1989;14(5):1253–1262.
Ballal RS, Nanda NC, Gatewood R, et al. Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation. 1991;84: 1903–1914.
Adachi H, Omoto R, Kyo S, et al. Emergency surgical intervention of acute aortic dissection with the rapid diagnosis by transesophageal echocardiography. Circulation. November 1991;84:14–19.
Simon P, Owen AN, Havel M, et al. Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection. J Thorac Cardiovasc Surg. 1992;103:1113–1117.
Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H. Echocardiography in diagnosis of aortic dissection. Lancet. March 4, 1989;1(8636): 457–461.
Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1–9.
Laissy JP, Blanc F, Soyer P, et al. Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging. Radiology. 1995;194: 331–336.
Bansal RC, Chandrasekaran K, Ayala K, Smith DC. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol. May 1995;25(6):1393–1401.
Keren A, Kim CB, Hu BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol. September 1996;28(3):627–636.
Vignon P, Guéret P, Vedrinne JM, et al. Role of transesophageal echocardiography in the diagnosis and management of traumatic aortic disruption. Circulation. November 15, 1995;92(10):2959–2968.
Pepi M, Campodonico J, Galli C, et al. Rapid diagnosis and management of thoracic aortic dissection and intramural haematoma: a prospective study of advantages of multiplane vs. biplane transoesophageal echocardiography. Eur J Echocardiogr. 2000;1: 72–79.
Nishino M, Tanouchi J, Tanaka K, et al. Transesophageal echocardiographic diagnosis of thoracic aortic dissection with the completely thrombosed false lumen: differentiation from true aortic aneurysm with mural thrombus. J Am Soc Echocardiogr. 1996;9:79–85.
Sommer T, Fehske W, Holzknecht N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology. 1996;199: 347–352.
Evangelista A, Garcia-del-Castillo H, Gonzalez-Alujas T, et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts. J Am Coll Cardiol. 1996;27:102–107.
Chirillo F, Cavallini C, Longhini C, et al. Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection. Am J Cardiol. 1994;74: 590–595.
Grossman CM, D’Augostino AN. Advanced atherosclerosis in false channels of chronic aortic dissection. Lancet. 1993;342:1428–1429.
Demertzis S, Casso G, Torre T, Siclari F. Direct epiaortic ultrasound scanning for the rapid confirmation of intraoperative aortic dissection. Interact Cardiovasc Thorac Surg. August 2008;7(4):725–726.
Kim CM, Yu SC, Hong SJ. Cardiac tamponade during transesophageal echocardiography in the patient of circumferential aortic dissection. J Korean Med Sci. June 1997;12(3):266–268.
Dalby Kristensen S, Ramlov Ivarsen H, Egeblad H. Rupture of aortic dissection during attempted transesophageal echocardiography. Echocardiography. July 1996;13(4):405–406.
Arima H, Sobue K, Tanaka S, Morishima T, Ando H, Katsuya H. Airway obstruction associated with transesophageal echocardiography in a patient with a giant aortic pseudoaneurysm. Anesth Analg. September 2002;95(3):558–560.
Triulzi M, Gilliam LD, Gentile F, et al. Normal cross sectional echocardiographic values: linear dimensions and chamber areas. Echocardiography. 1984;1: 403–426.
Fossier AE. Size of the normal aorta. Ann Clin Med. 1924;3:525.
Massabuau P. Transesophageal echocardiography for diagnosis and treatment of aortic diseases. In: Rousseau H, Verhoye JP, Heautot JF, eds. Thoracic Aortic Diseases. 1st ed. Berlin/Heidelberg: Springer; 2006:33–53.
Roberts WC, Honing HS. The spectrum of cardiovascular disease in Marfan syndrome: a clinico-morphologic study of 18 necropsy patients and comparison to 151 previously reported necropsy patients. Am Heart J. 1982;104:115–135.
Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J. September 2001;22(18):1642–1681.
Mohr-Kahaly S, Erbel R, Rennollet H, et al. Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation. July 1989;80(1): 24–33.
Adachi H, Kyo S, Takamoto S, Kimura S, Yokote Y, Omoto R. Early diagnosis and surgical intervention of acute aortic dissection by transesophageal color flow mapping. Circulation. November 1990;82(Suppl 4):19–23.
Evangelista A, Gonzalez-Alujas T. Pathophysiology of aortic dissection. In: Rousseau H, Verhoye JP, Heautot JF, eds. Thoracic Aortic Diseases. 1st ed. Berlin/Heidelberg: Springer; 2006:33–53.
Ergin MA, Phillips RA, Galla JD, et al. Significance of distal false lumen after type A dissection repair. Ann Thorac Surg. April 1994;57(4): 820–824.
Erbel R, Oelert H, Meyer J, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation. May 1993;87(5):1604–1615.
Moore NR, Parry AJ, Trottman-Dickenson B, Pillai R, Westaby S. Fate of the native aorta after repair of acute type A dissection: a magnetic resonance imaging study. Heart. 1996 Jan;75(1):62–66.
Barron DJ, Livesey SA, Brown IW, Delaney DJ, Lamb RK, Monro JL. Twenty-year follow-up of acute type a dissection: the incidence and extent of distal aortic disease using magnetic resonance imaging. J Card Surg. May–June 1997;12(3):147–159.
Erbel R, Mohr-Kahaly S, Rennollet H, et al. Diagnosis of aortic dissection: the value of transesophageal echocardiography. Thorac Cardiovasc Surg. November 1987;35(Spec No 2): 126–133.
Roberts WC. Aortic dissection: anatomy, consequences and causes. Am Heart J. 1981;101:195-214.
Iliceto S, Nanda NC, Rizzon P, et al. Color Doppler evaluation of aortic dissection. Circulation. April 1987;75(4):748–755.
Chan KL. Usefulness of transesophageal echocardiography in the diagnosis of conditions mimicking aortic dissection. Am Heart J. August 1991;122(2): 495–504.
Movsowitz HD, Levine RA, Hilgenberg AD, Isselbacher EM. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valverepair. J Am Coll Cardiol. September 2000;36(3):884–890.
Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg. June 1993;55(6): 1513–1517.
Penn MS, Smedira N, Lytle B, Brener SJ. Does coronary angiography before emergency aortic surgery affect in-hospital mortality? J Am Coll Cardiol. March 15, 2000;35(4):889–894.
Orihashi K, Matsuura Y, Sueda T, et al. Abdominal aorta and visceral arteries visualized with transesophageal echocardiography during operations on the aorta. J Thorac Cardiovasc Surg. April 1998;115(4):945–947.
Voci P, Tritapepe L, Testa G, Caretta Q. Imaging of the anterior spinal artery by transesophageal color Doppler ultrasonography. J Cardiothorac Vasc Anesth. October 1999;13(5):586–587.
Orihashi K, Sueda T, Okada K, Imai K. Perioperative diagnosis of mesenteric ischemia in acute aortic dissection by transesophageal echocardiography. Eur J Cardiothorac Surg. December 2005;28(6):871–876.
Chandrasekaran K, Edwards WD, Malouf JF, Gillman G, Oh JK. Role of echocardiography in the diagnosis of aortic dissection. In: Baliga RR, Nienaber CA, Isselbacher EM, Eagle KA, eds. Aortic Dissection and Related Syndromes. 1st ed. New York: Springer; 2007:61–85.
Vignon P, Rambaud G, François B, Preux PM, Lang RM, Gastinne H. Quantification of traumatic hemomediastinum using transesophageal echocardiography: impact on patient management. Chest. June 1998;113(6):1475–1480.
Juvonen T, Ergin MA, Galla JD, et al. Risk factors for rupture of chronic type B dissections. J Thorac Cardiovasc Surg. April 1999;117(4):776–786.
Heinemann M, Laas J, Karck M, Borst HG. Thoracic aortic aneurysms after acute type A aortic dissection: necessity for follow-up. Ann Thorac Surg. April 1990;49(4):580–584.
San Román JA, Vilacosta I, Castillo JA, Rollán MJ, Sánchez-Harguindey L. Role of transesophageal echocardiography in the assessment of patients with composite aortic grafts for therapy in acute aortic dissection. Am J Cardiol. March 1, 1994;73(7):519–521.
Roberts WC, Honig HS. The spectrum of cardiovascular disease in the Marfan syndrome: a clinico-morphologic study of 18 necropsy patients and comparison to 151 previously reported necropsy patients. Am Heart J. July 1982;104(1):115–135.
Nienaber CA, von Kodolitsch Y, Petersen B, et al. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation. September 15, 1995;92(6):1465–1472.
Sheldon WS, Vandervoort PM, Black IW, Grimm RA, Stewart WJ. Aortic intramural hematoma in patients evaluated for aortic dissection: clinical, echocardiographic, radiologic and pathologic findings. Circulation. 1994;90(Suppl I):I385.
Vilacosta I, de Dios RM, Pinto AG. Aortic intramural hematoma during coronary angioplasty: insights into the pathogenesis of intramedial hemorrhage. J Am Soc Echocardiogr. 2000;13:403–406.
Song J-K. Diagnosis of intramural hematoma. Heart. 2004;90:368–371.
Song JM, Kang DH, Song JK, et al. Clinical significance of echo-free space detected by transesophageal echocardiography in patients with type B aortic intramural hematoma. Am J Cardiol. March 1, 2002;89(5): 548–551.
Evangelista A, Dominguez R, Sebastia C, et al. Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma. Therapeutic implications. Eur Heart J. January 2004;25(1):81–87.
Keren A, Kim CB, Hu BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol. September 1996;28(3):627–636.
Ganaha F, Miller DC, Sugimoto K, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. July 16, 2002;106(3): 342–348.
Kaji S, Nishigami K, Akasaka T, et al. Prediction of progression or regression of type A aortic intramural hematoma by computed tomography. Circulation. November 9, 1999;100(19 Suppl):II281–II286.
Song JM, Kim HS, Song JK, et al. Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. Circulation. September 9, 2003;108(Suppl 1):II324–II328.
Vilacosta I, San Román JA, Aragoncillo P, et al. Penetrating atherosclerotic aortic ulcer: documentation by transesophageal echocardiography. J Am Coll Cardiol. July 1998;32(1):83–89.
Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population based study. Surgery. 1982;92:1103–1109.
Iung B, Gohlke-Barwolf C, Tornos P, et al. Recommendations on the management of the asymptomatic patient with valvular heart disease. Eur Heart J. 2002;23:1253–1266.
Baldari D, Chiu S, Salciccioli L. Aortic pseudoaneurysm as a rare cause of superior vena cava syndrome – a case report. Angiology. May–June 2006;57(3):363–366.
Deng YB, Li CL, Chang Q. Chronic traumatic pseudoaneurysm of the ascending aorta causing right ventricular inflow obstruction. Circ J. April 2003;67(4): 359–361.
Revilla A, San Román JA, Fernández-Avilés F. Images in cardiology. Aortopulmonary fistula in an acute aortic syndrome. Heart. March 2006; 92(3):360.
Rognoni A, Iorio S, Leverone M, Marino P. Aortic pseudoaneurysm and aorta-right atrium fistula: a case report. G Ital Cardiol (Rome). March 2006;7(3): 234–237.
Yokote Y, Kyo S, Matsumura M, Asano H, Tanabe H, Omoto R. Aortobiventricular fistulas associated with pseudoaneurysm of the ascending aorta 12 years after patch repair of supravalvular aortic stenosis. Jpn J Thorac Cardiovasc Surg. February 2001;49(2): 132–134.
Kanani RS, Neilan TG, Palacios IF, Garasic JM. Novel use of the Amplatzer septal occluder device in the percutaneous closure of ascending aortic pseudoaneurysms: a case series. Catheter Cardiovasc Interv. January 2007;69(1):146–153.
Smith MD, Cassidy JM, Souther S, et al. Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med. 1995;332:356–362.
Vignon P, Gueret P, Vedrinne JM, et al. Role of transesophageal echocardiography in the management of traumatic aortic disruption. Circulation. 1995;92: 2959–2968.
Swaminathan M, Lineberger CK, McCann RL, Mathew JP. The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms. Anesth Analg. 2003;97(6):1566–1572.
Rapezzi C, Rocchi G, Fattori R, et al. Usefulness of transesophageal echocardiographic monitoring to improve the outcome of stent-graft treatment of thoracic aortic aneurysms. Am J Cardiol. 2001;87(3): 315–319.
Moskowitz DM, Kahn RA, Konstadt SN, Mitty H, Hollier LH, Marin ML. Intraoperative transoesophageal echocardiography as an adjuvant to fluoroscopy during endovascular thoracic aortic repair. Eur J Vasc Endovasc Surg. 1999;17(1):22–27.
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331(26): 1729–1734.
Van der Starre P, Guta C, Dake M, Ihnken K, Robbins R. The value of transesophageal echocardiography for endovascular graft stenting of the ascending aorta. J Cardiothorac Vasc Anesth. 2004;18(4):466–468.
Song TK, Donayre CE, Kopchok GE, White RA. Intravascular ultrasound use in the treatment of thoracoabdominal dissections, aneurysms and transactions. Semin Vasc Surg. 2006;19:145–149.
Fayed A. Images in anesthesia; a misplaced guide wire in the false lumen during endovascular repair of a type B aortic dissection. Can J Anesth. 2007;54: 947–948.
Dobson G, Petrasek P, Alvarez N. Images in anesthesia: transesophageal echocardiography enhances endovascular stent placement in traumatic trans-section of the thoracic aorta. Can J Anaesth. 2004;51(9):931.
Martin M, Moris C, Hevia S, et al. Intimal dehiscence during endovascular treatment of thoracic aortic dissection. Int J Cardiol. 2006;114:e1–e2.
Misfeld M, Notzold A, Geist V, Richardt G, Sievers HH. Retrograde type A dissection after endovascular stent grafting of type B dissection. Z Kardiol. 2002;91:274–277.
Fayed A. Thoracic endovascular stent graft with a bird’s beak sign. Can J Anaesth. 2008;55:785-786.
Fayed A. Echocardiography images of endovascular mal-aligned stent grafts. Can J Anesth. 2008;55: 306–307.
White GH, Yu W, May J, Chaufour X, Stephen MS. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg. 1997;4(2):152–168.
Malina M, Lanne T, Ivancev K, Lindblad B, Brunkwall J. Reduced pulsatile wall motion of abdominal aortic aneurysms after endovascular repair. J Vasc Surg. 1998;27(4):624–631.
Alimi YS, Chakfe N, Rivoal E, et al. Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction. J Vasc Surg. 1998;28(1):178–183.
Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029–1035.
Dobson G, Maher N, Ball M, Kryski A, Moore R. Images in anesthesia: echo contrast as an adjunct to intraoperative angiography in the detection of endoleaks. Can J Anaesth. 2006;53(5):516–517.
Hughes GC, Sulzer CF, McCann RL, Swaminathan M. Endovascular Approaches to Complex Thoracic Aortic Disease. Semin Cardiothorac Vasc Anesth. 2008;12:298–319.
Fattori R, Caldarera I, Rapezzi C, et al. Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg. 2000;120(3):490–495.
Gonzalez-Fajardo JA, Gutierrez V, San Roman JA, et al. Utility of intraoperative transesophageal echocardiography during endovascular stent-graft repair of acute thoracic aortic dissection. Ann Vasc Surg. 2002;16(3):297–303.
Napoli V, Bargellini I, Sardella SG, et al. Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair. Radiology. 2004;233(1):217–225.
Koschyk DH, Nienaber CA, Knap M, et al. How to guide stent-graft implantation in type B aortic dissection? Comparison of angiography, transesophageal echocardiography, and intravascular ultrasound. Circulation. 2005;112(9 Suppl):I260–I264.
Koschyk DH, Meinertz T, Hofmann T, et al. Value of intravascular ultrasound for endovascular stent-graft placement in aortic dissection and aneurysm. J Card Surg. 2003;18(5):471–477.
Orihashi K, Matsuura Y, Sueda T, et al. Echocardiography-assisted surgery in transaortic endovascular stent grafting: role of transesophageal echocardiography. J Thorac Cardiovasc Surg. 2000;120(4):672–678.
Rocchi G, Lofiego C, Biagini E, et al. Transesophageal echocardiography-guided algorithm for stent-graft implantation in aortic dissection. J Vasc Surg. 2004;40(5):880–885.
Freeman WK. Diseases of the thoracic aorta: assessment by transesophageal echocardiography. In: Freeman WK, Seward JB, Khandheria BK, Tajik AJ, eds. Transesophageal Echocardiography. Boston, MA: Little, Brown and Co; 1994.
Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesathesiologists and the Society of Cardiovascular Anesthesiologists Task force on Transesophageal Echocardiography. Anesthesiology. 1996;84:986.
Swaminathan M et al. The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms. Anesth Analg. 2003;97:1566–1572.
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Subramaniam, K., Subramaniam, B. (2011). Role of Echocardiography in Aortic Surgery. In: Subramaniam, K., Park, K., Subramaniam, B. (eds) Anesthesia and Perioperative Care for Aortic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85922-4_4
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