Abstract
Using a defined angle T, which can be measured noninvasively using Doppler ultrasound, we aim to determine the location of the intimal breach in Stanford type B aortic dissection (AD) and estimate the risk of AD using that measurement. Our subjects included 86 healthy volunteers, 60 hypertensive patients, and 42 patients with Stanford type B AD. We used dual functional color Doppler ultrasound to locate the central point of the high-speed flow zone within the descending aorta, and then calculated the angle T, using the law of cosines. In addition, we measured the degree of distortion within the descending aorta using Line BD, defined as the distance from the lateral edge of the left subclavian artery (LSA) to the center of the breach in the intima in AD. The value of T was approximately 24° ± 3° and was constant across all 3 groups. In addition, the increase in BD distance corresponded to increased distortion in the descending aorta between the LSA and the region of aortic artery ligament (RAALE). We found that when the preoperative BD was less than 2.6 cm, the aortic arch could be straightened, using a stent-graft, to approximate the normal aorta. When the preoperative BD is less than 2.6 cm, the aortic arch can be corrected using a stent. In addition, since the T angle is constant, we speculate that it can be used to predict the risk of intimal breach and estimate its location using digital subtraction angiography (DSA) to guide surgery.
Similar content being viewed by others
Abbreviations
- RAALE:
-
Aortic artery ligament extension
- AD:
-
Aortic dissection
- DSA:
-
Digital subtraction angiography
- LSA:
-
Left subclavian artery
References
Prisant LM, Prasad NVR (2005) Aortic dissection. J Clin (Greenwich) Hypertens 7:367–371
Tang J, Jing Z, Xiong J et al (2004) Relationship between undulate hypertension and divided artery middle membrane. Chin J Exp Surg 21:604–605
Wheat MWJR (1980) Acute dissecting aneurysms of the aorta: diagnosis and treatment-1979. Am Heart J 99(3):373–387
Hu JL, Xu LP (2000) The basic knowledge of rheology. Beijing Science Press, Beijing, pp 1–38
Juvonen T, Ergin MA, Galla JD et al (1999) Risk factors for rupture of chronic type B dissections. J Thorac Cardiovasc Surg 117:776–786
Frangos SG, Gahtan V, Sumpio B (1999) Localization of atherosclerosis: role of hemodynamics. Arch Surg 134:1142–1149
Lh Z, Dong SH, Li C, Yang CY, Wen AH, Chen Y (2001) Ambulatory pulse pressure in hypertensive patients with carotid artery atherosclerosis studies. China J Arter 02:145
Ye Y, Zhao BZ, Tang JD (2007) Color Doppler ultrasound in the study of hemodynamics of descending aorta. J China Clin Med Imaging 02:104–105
Effmann E, Whitman SA, Smith BP (1986) Aortic arch development. Radiographics 6:1065–1189
Eagle KA, Isselbacher EM, DeSanctis RW (2002) Cocaine-related aortic dissection in perspective. Circulation 105:1529
Zhong M, Su H, Yue X, Zhao J, Zhang Y, Zhang W (2005) The relationship of essential hypertension and aortic dissection. Chin J Arter 13:491–493
Shimojo M, Tsuda N, Iwasaka T, Inada M (1991) Age-related changes in aortic elasticity determined by gated radionuclide angiography in patients with systemic hypertension or healed myocardial infarcts and in normal subjects. Am J Cardiol 68:950–953
Marui A, Mochizuki T, Mitsui N et al (1999) Toward the best treatment for uncomplicated patients with type B acute aortic dissection: a consideration for sound surgical indication. Circulation 100:II275–II280
Masuda Y, Yamada Z, Morooka N, Watanabe S, Inagaki Y (1991) Prognosis of patients with medically treated aortic dissection. Circulation 84:III7–III13
Glower DD, Fann JI, Speier RH et al (1990) Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation 82:IV39–IV46
Haverich A, Miller DC, Scott WC, Mitchell RS, Oyer PE, Stinson EB (1985) Acute and chronic aortic dissections: determinates of long-term outcome for operative survivors. Circulation 72:II22–II34
Sueyoshi E, Sakamoto I, Hayashi K, Yamaguchi T, Imada T (2004) Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation 110:II256–II261
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tang, J., Wang, Y., Hang, W. et al. Preliminary report on a sonographic method to determine the location of the intimal breach in Stanford type B aortic dissection. Int J Cardiovasc Imaging 27, 83–90 (2011). https://doi.org/10.1007/s10554-010-9663-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-010-9663-7