Advertisement

Disease of the Aorta

  • Azin Alizadehasl
  • Anita Sadeghpour
Chapter
  • 891 Downloads

Abstract

Echocardiography plays an essential role in the diagnosis, management plans, and follow-up of aortic diseases. Study of the aorta is a routine part of the standard echocardiographic examination. Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, mainly the aortic root and the proximal ascending aorta. Transesophageal echocardiography (TEE) overcomes the limitations of TTE in the evaluation of the thoracic aorta. TEE must be used in a complementary manner. Echocardiography is useful and valuable for assessing the size, biophysical properties, and atherosclerotic involvement of the thoracic aorta. Although TEE is a useful method in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in the proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. Nonetheless, a negative TTE does not rule out aortic dissection and other imaging modalities should be considered. TEE must define entry tear location, mechanisms and severity of aortic regurgitation, and also true lumen compression. Additionally, echocardiography is crucial in selecting and monitoring surgical and endovascular treatment and in noticing possible complications. Even though other imaging techniques such as computed tomography and magnetic resonance imaging have a greater field of view and can yield complementary information, echocardiography is accurate, portable, rapid, and cost-effective in the diagnosis, management plans, and follow-up of most aortic diseases.

Keywords

Aortic diseases Transesophageal echocardiography Transthoracic echocardiography Aneurysm of aorta Aortic dissection Intramural hematoma (IMH) Coarctation (COA) Pseudoaneurysms 

Abbreviations

AV

Aortic valve

BSA

Body surface area

COA

Coarctation

CT

Computed tomography

IMH

Intramural hematoma

MRI

Magnetic resonance imaging

STJ

Sinotubular junction

TEE

Transesophageal echocardiography

TTE

Transthoracic echocardiography

Supplementary material

Movie 38.1

Mobile dissecting flap obviously is visible in transthoracic echocardiography in systole and diastole that interfere with Aortic valve closure resulting sever aortic regurgitation in long axis and short axis view of transthoracic echocardiography (AVI 5123 kb)

Movie 38.2

Mobile dissecting flap obviously is visible in transthoracic echocardiography in systole and diastole that interfere with Aortic valve closure resulting sever aortic regurgitation in long axis and short axis view of transthoracic echocardiography (AVI 1436 kb)

Movie 38.3

Left thin, mobile linear echogenicity in the artic root with interference with Aortic valve suggesting for acute type A acute aortic dissection (AVI 4912 kb)

Movie 38.4

Left thin, mobile linear echogenicity in the artic root with interference with Aortic valve suggesting for acute type A acute aortic dissection (AVI 4900 kb)

Movie 38.5

Thick and fixed linear echogenicity associated with aneurysmal dilatation of aortic root in a Marfan syndrome (AVI 21858 kb)

Movie 38.6

Intramural hematoma in short axis and long axis of the descending thoracic aorta (AVI 5699 kb)

Movie 38.7

Complex atherosclerotic plaque of descending thoracic aorta (AVI 8392 kb)

References

  1. 1.
    Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012;56:565.CrossRefGoogle Scholar
  2. 2.
    Goldstein S, Evangelista A, Abbara S, Arai A, Asch F, Badano L, et al. Multimodality imaging of diseases of the thoracic aorta in adults. Am Soc Echocardiogr. 2015;28:119–82.CrossRefGoogle Scholar
  3. 3.
    Evangelista A, Flachskampt FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, Sicari R, Nihoannopoulos P, Zamorano J; European Association of Echocardiography; Document Reviewers: Pepi M, Breithardt OA, Plonska-Gosciniak E. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010;11(8):645–58.Google Scholar
  4. 4.
    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. Circulation. 2010;e266(2010):121.Google Scholar
  5. 5.
    Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M, et al. European Association of Echocardiography for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008;9:438–48.CrossRefGoogle Scholar
  6. 6.
    Orihashi K, Matsuura Y, Sueda T, Watari M, Okada K, Sugawara Y, et al. Aortic arch branches are no longer a blind zone for transesophageal echocardiography: a new eye for aortic surgeons. J Thorac Cardiovasc Surg. 2000;120:466–72.CrossRefGoogle Scholar
  7. 7.
    Roberts WC, Vowels TJ, Ko JM, et al. Comparison of the structure of the aortic valve and ascending aorta in adults having aortic valve replacement for aortic stenosis versus for pure aortic regurgitation and resection of the ascending aorta for aneurysm. Circulation. 2011;123:896.CrossRefGoogle Scholar
  8. 8.
    Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010;122:184.CrossRefGoogle Scholar
  9. 9.
    Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37:149.CrossRefGoogle Scholar
  10. 10.
    LeMaire SA, McDonald ML, Guo DC, et al. Genome-wide association study identifies a susceptibility locus for thoracic aortic aneurysms and aortic dissections spanning FBN1 at 15q21.1. Nat Genet. 2011;43:996.CrossRefGoogle Scholar
  11. 11.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA. 2000;283:897.CrossRefGoogle Scholar
  12. 12.
    Estrera A, Miller C III, Lee TY, et al. Acute type A intramural hematoma: analysis of current management strategy. Circulation. 2009;120:S287.CrossRefGoogle Scholar
  13. 13.
    Eggebrecht H, Plicht B, Kahlert P, et al. Intramural hematoma and penetrating ulcers: indications to endovascular treatment. Eur J Vasc Endovasc Surg. 2009;38:659.CrossRefGoogle Scholar
  14. 14.
    Bischoff MS, Geisbusch P, Peters AS, et al. Penetrating aortic ulcer: defining risks and therapeutic strategies. Herz. 2011;36:498.CrossRefGoogle Scholar
  15. 15.
    Nathan DP, Boonn W, Lai E, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012;55:10.CrossRefGoogle Scholar
  16. 16.
    Soto ME, Espinola-Zavaleta N, Ramirez-Quito O, Reyes PA. Echocardiographic follow-up of patients with Takayasu's arteritis: five-year survival. Echocardiography. 2006 May;23(5):353–60.CrossRefGoogle Scholar
  17. 17.
    Hsu RB, Lin FY. Infected aneurysm of the thoracic aorta. J Vasc Surg. 2008;47:270.CrossRefGoogle Scholar
  18. 18.
    Sedivy P, Spacek M, El Samman K, et al. Endovascular treatment of infected aortic aneurysms. Eur J Vasc Endovasc Surg. 2012;44:385.CrossRefGoogle Scholar
  19. 19.
    Laser A, Baker N, Rectenwald J, et al. Graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2011;54:58.CrossRefGoogle Scholar
  20. 20.
    Restrepo CS, Betancourt SL, Martinez-Jimenez S, et al. Aortic tumors. Semin Ultrasound CT MR. 2012;33:265.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Azin Alizadehasl
    • 1
  • Anita Sadeghpour
    • 2
  1. 1.Associate Professor of Cardiology, Echocardiologist, Echocardiography and Cardiogenetic Research CentersCardio-Oncology Department, Rajaie Cardiovascular Medical and Research CenterTehranIran
  2. 2.Professor of CardiologyEchocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran

Personalised recommendations