International Journal of Angiology

, Volume 4, Issue 3, pp 151–154

Diagnosis of aortic dissection: The value and limitations of transesophageal echocardiography

  • Anna Paczek
  • Wanda Rydlewska-Sadowska
Original Articles


Aortic dissection requires prompt and reliable diagnosis. The purpose of this study was to assess the accuracy and limitations of transesophageal echocardiography (TEE) for the diagnosis of aortic dissection. Twenty seven patients with clinically suspected aortic dissection were investigated by means of TEE. TEE results were compared to intraoperative findings (n=18), necropsy (n=4), and magnetic resonance imaging (n=5). The DeBakey classification was used for differentiation of dissection type. Twenty-three patients (85%) were correctly identified as having aortic dissection. Four false-positive TEE findings (15%) were confined to the nondissecting aneurysm of the ascending aorta in elderly patients. Retrospectively we found that protruding atherosclerotic plaques were recognized as small intimal flaps. Type of dissection was correctly diagnosed in all 23 patients, the primary entry site was identified in 15 patients (65%), aortic regurgitation was found in 55.5% of patients, and pericardial effusion was detected in 33.3%. We conclude that TEE allows accurate diagnosis and classification of aortic dissection. However, some cases could be overdiagnosed in lesions of the ascending aorta, especially in nondissecting aneurysms. Another limitation of TEE is the inability to define the primary entry site in some cases. Still, overall results may favor TEE as the primary bedside diagnostic procedure to identify patients requiring urgent surgical intervention.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Erbel R, Mohr-Kahaly S, Rennollet J, Drexler M, Wittlich N, Iversen S, Oelert H, Thelen M, Meyer J (1987) Diagnosis of aortic dissection: The value of transesophageal echocardiography. Thorac Cardiovasc Surg 35:126–133.Google Scholar
  2. 2.
    Simon P, Owen AN, Havel M, Moidl R, Hiesmayer M, Wolner E, Mohl W (1992) Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection. J Thorac Cardiovasc Surg 103:1113–1118.PubMedGoogle Scholar
  3. 3.
    Nienaber CA, Spielmann RP, von Kodolitch Y, Siglow V, Piepho A, Jaup T, Nicolas V, Weber P, Triebel H-J, Bleifeld W (1992) Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation 85:434–447.PubMedGoogle Scholar
  4. 4.
    Erbel R, Daniel W, Visser C, Engberding R, Roelandt J, Rennollet H (1989) Echocardiography in diagnosis of aortic dissection. Lancet, March 4, 457–461.Google Scholar
  5. 5.
    Mohr-Kahaly S, Erbel R, Rennollet H, Wittlich N, Drexler M, Oelert H, Meyer J (1989) Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation 80:24–33.PubMedGoogle Scholar
  6. 6.
    Goldman AP, Kotler MN, Scanlon MH, Oesteum B, Paramesuanan R, Parry WR (1986) The complementory role of magnetic resonance imaging, Doppler echocardiography and computed tomography in the diagnosis of dissecting thoracic aneurysms. Am Heart J 111:970–981.CrossRefPubMedGoogle Scholar
  7. 7.
    Dinsmore RE, Liberthson RR, Wismer GL, Miller SW, Liu P, Thompson R, McLoud TC, Marshall J, Saini S, Stratemeier EJ, Okada RD, Brady TJ (1986) Magnetic resonance imaging of the thoracic aortic aneurysms: Comparison with other imaging methods. Am J Roentgenol 146:309–314.Google Scholar
  8. 8.
    Hirst AE, Johns VJ, Kime SW (1958) Dissecting aneurysm of the aorta: A review of 505 cases. Medicine 37:217.PubMedGoogle Scholar
  9. 9.
    Miller DC, Stinson EB, Oyer PE, Rossiter SJ, Reitz BA, Griepp RB, Shumway NE (1979) Operative treatment of aortic dissections. J Thorac Cardiovasc Surg 78:365–382.PubMedGoogle Scholar
  10. 10.
    Engberding R, Bender F, Grosse Heitmeyer W, Mort E, Muller KS, Bramann HK, Schroder D (1986) Identification of dissection or aneurysm of descending thoracic aorta by conventional and transesophageal two-dimensional echocardiography. Am J Cardiol 59:717–719.CrossRefGoogle Scholar
  11. 11.
    Borner N, Erbel R, Braun B, Henkel B, Meyer J, Rumpelt J (1984) Diagnosis of aortic dissection by transesophageal echocardiography. Am J Cardiol 54:1157–1158.PubMedGoogle Scholar
  12. 12.
    Erbel R, Borner N, Steller D, Brunier J, Thelen M, Pfeiffer C, Mohr-Kahaly S, Meyer J (1987) Detection of aortic dissection by transesophageal echocardiography. Br Heart J 58:45–51.PubMedGoogle Scholar
  13. 13.
    Matsuzaki M, Toma Y, Kusukawa R (1990) Clinical applications of transesophageal echocardiography. Circulation 82:709–722.PubMedGoogle Scholar
  14. 14.
    Iliceto S, Ettorne G, Francioso G, Antonelli G, Biasco G, Rizzon P (1984) Diagnosis of aneurysm of the thoracic aorta. Comparison between two noninvasive techniques: Two-dimensional echocardiography and computed tomography. Eur Heart J 5: 545–555.PubMedGoogle Scholar
  15. 15.
    Bresnihan ER, Keates PG (1980) Ultrasound and dissection of the abdominal aorta. Clin Radiol 31:105.CrossRefPubMedGoogle Scholar
  16. 16.
    Takamoto S, Kyo S, Matsumara M, Hojo H, Yokote Y, Omoto R (1986) Total visualization of thoracic dissecting aortic aneurysm by transesophageal Doppler color flow mapping. Circulation (suppl II): 132.Google Scholar
  17. 17.
    Iliceto S, Nanda NC, Rizzon P, Hsuing MC, Goyal RG, Amico A, Sorino M (1987) Color Doppler evaluation of aortic dissection. Circulation 75:748–755.PubMedGoogle Scholar
  18. 18.
    Bansal RC, Shakudo M, Shah PM, Shah PM (1990) Biplane transesophageal echocardiography: Technique, image orientation, and preliminary experience in 131 patients. J Am Soc Echo 3:348–366.Google Scholar
  19. 19.
    Omoto R, Kyo S, Matsumara M, Shah PM, Adachi H, Yokote Y, Kondo Y (1992) Evaluation of biplane color Doppler transesophageal echocardiography in 200 consecutive patients. Circulation 85:1237–1247.PubMedGoogle Scholar
  20. 20.
    Granato JE, Dee P, Gibson RS (1985) Utility of two-dimensional echocardiography in suspected ascending aortic dissection. Am J Cardiol 56:123.CrossRefPubMedGoogle Scholar

Copyright information

© International College of Angiology, Inc. 1995

Authors and Affiliations

  • Anna Paczek
    • 1
  • Wanda Rydlewska-Sadowska
    • 1
  1. 1.National Institute of CardiologyWarsawPoland

Personalised recommendations