Advertisement

Thoracic Aorta

  • Timothy M. MausEmail author
Chapter

Abstract

The close proximity of the esophagus to the thoracic aorta provides an excellent imaging opportunity. Transesophageal echocardiography (TEE) serves an important role in several important pathologies including aortic dissection, aortic aneurysms, aortic atheromatous disease, and aortic trauma. A thorough understanding of the use of TEE in evaluating the thoracic aorta including normal and pathologic presentations is essential to the basic perioperative echocardiographer. However, knowledge of the limitations of the modality is also key to appropriate patient management and preventing mismanagement.

Keywords

Thoracic aorta Aortic dissection Aortic aneurysm Atheromatous disease Plaque Blunt aortic trauma 

Supplementary material

Video 10.1

Midesophageal aortic valve long axis view with the probe slightly withdrawn to demonstrate more of the tubular ascending aorta (M4V 1,439 KB)

Video 10.2

Midesophageal view of ascending aorta developed by a slow withdrawal of the probe from an aortic valve short axis (M4V 641 KB)

Video 10.3

Upper esophageal aortic arch short axis view in a patient with an acute aortic arch dissection (M4V 1,380 KB)

Video 10.4

Midesophageal ascending aortic short axis view in a patient with an ascending aortic dissection (M4V 738 KB)

Video 10.5a

Midesophageal ascending aortic short axis view in a patient with a side lobe artifact. The linear density in the ascending aorta may be confused with an aortic dissection (AVI 2,544 KB)

Video 10.5b

Midesophageal ascending aortic long axis view of the same patient. The side lobe artifact may be confused for an aortic dissection (AVI 2,678 KB)

Video 10.6a

Descending thoracic aortic short axis view in a patient with an aortic dissection. Note the large left sided pleural effusion (MP4 912 KB)

Video 10.6b

Descending thoracic aortic short axis view with color flow Doppler in a separate patient with an aortic dissection. Note the laminar flow in the true lumen and the red arrow indicates the false lumen with sluggish flow (MP4 412 KB)

330609_1_En_10_MOESM9_ESM.m4v (257 kb)
Video 10.7a Midesophageal aortic valve long axis view in a patient with an ascending aortic dissection (M4V 257 KB)
Video 10.7b

Midesophageal aortic valve long axis view in a separate patient with an ascending aortic dissection. Note the intimal tear with diastolic flow reversing back into the true lumen from the false lumen (M4V 781 KB)

Video 10.8

Descending thoracic aortic short axis view with color flow Doppler in a patient with an aortic dissection and a large left pleural effusion (M4V 758 KB)

Video 10.9a

Midesophageal aortic valve long axis view in a patient with an ascending aortic dissection (M4V 926 KB)

Video 10.9b

Midesophageal aortic valve short axis view in the same patient. The intimal flap is located abutted the right coronary ostium (M4V 952 KB)

Video 10.10

Midesophageal aortic valve short axis view in a patient with a bicuspid valve and ascending aortic aneurysm. Note the dilated annulus (M4V 907 KB)

Video 10.11

Midesophageal aortic valve short axis view with color flow Doppler in a patient with an ascending aortic aneurysm (M4V 738 KB)

Video 10.12a

Descending thoracic aortic short axis view demonstrating complex atheromatous disease (M4V 481 KB)

Video 10.12b

Descending thoracic aortic long axis view of the same patient (M4V 436 KB)

References

  1. 1.
    Khalil A, Helmy T, Porembka DT. Aortic pathology: aortic trauma, debris, dissection, and aneurysm. Crit Care Med. 2007;35:S392–400.CrossRefPubMedGoogle Scholar
  2. 2.
    Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385:800–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166:1350–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Reeves ST, Finley AC, Skubas NJ, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr. 2013;26:443–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Hata N, Tanaka K, Imaizumi T, et al. Clinical significance of pleural effusion in acute aortic dissection. Chest. 2002;121:825–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart association task force on practice guidelines, American Association for thoracic surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55:e27–129.CrossRefPubMedGoogle Scholar
  7. 7.
    Wilton E, Jahangiri M. Post-stenotic aortic dilatation. J Cardiothorac Surg. 2006;1:7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Goldstein SA, Evangelista A, Abbara S, et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American society of echocardiography and the european association of cardiovascular imaging: endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2015;28:119–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of California San DiegoSan DiegoUSA

Personalised recommendations