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The role of contrast enhanced transesophageal echocardiography in the diagnosis and in the morphological and functional characterization of acute aortic syndromes

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Abstract

The aim of this study is to evaluate the role of contrast transesophageal echocardiography (cTEE) in the diagnostic characterization of acute aortic syndromes (AAS) [aortic dissection, intramural hematoma, penetrating ulcer]. We enrolled 66 non-consecutive patients with clinical suspicion of AAS. Standard transesophageal echocardiography and cTEE were performed prior to gated-CT angiography, which has been assumed as reference standard. cTEE was obtained with a single bolus of contrast agent injection. The definitive diagnosis of AAS was made in 48 patients by gated-CT angiography: 22 aortic dissections, 15 intramural hematomas and 11 penetrating aortic ulcers. Standard TEE and cTEE correctly diagnosed AAS in 87 and 100 % (P = 0.03) cases respectively. Standard TEE correctly diagnosed aortic dissection in 20/22 (91 %) and cTEE in 22/22 (100 %) (P = 0.5) cases. cTEE was superior than standard TEE in the visualization of false lumen entry tear (22/22 vs. 16/22, P = 0.03). Standard TEE correctly diagnosed intramural hematoma in 11/15 and cTEE 15/15 (P = 0.12) cases. Microtears were identified in 3 patients by cTEE an in 1 patient by standard TEE (P = 0.4). The presence of focal contrast enhancement was identified in 4 and 0 patients by cTEE and standard TEE respectively (P = 0.06). Both standard and cTEE correctly diagnosed penetrating aortic ulcer in 11/11 (100 %) (P = 1.0) cases. cTEE provides additional value over standard TEE in the diagnosis and in the anatomic and functional characterization of AAS.

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Authors and Affiliations

  1. Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132, Milan, Italy

    Eustachio Agricola, Massimo Slavich, Andrea Fisicaro, Michele Oppizzi, Vincenzo Tufaro & Alberto Margonato

  2. Division of Vascular Surgery, San Raffaele Hospital, IRCCS, Milan, Italy

    Luca Bertoglio, Enrico Marone, Germano Melissano & Roberto Chiesa

Authors
  1. Eustachio Agricola
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  2. Massimo Slavich
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  3. Luca Bertoglio
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  4. Andrea Fisicaro
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  5. Michele Oppizzi
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  6. Enrico Marone
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  7. Germano Melissano
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  8. Vincenzo Tufaro
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  9. Alberto Margonato
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  10. Roberto Chiesa
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Correspondence to Massimo Slavich.

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Dr. Eustachio Agricola and Dr. Massimo Slavich equally contributed to the work, therefore should be considered as joint first author.

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Agricola, E., Slavich, M., Bertoglio, L. et al. The role of contrast enhanced transesophageal echocardiography in the diagnosis and in the morphological and functional characterization of acute aortic syndromes. Int J Cardiovasc Imaging 30, 31–38 (2014). https://doi.org/10.1007/s10554-013-0290-y

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  • DOI: https://doi.org/10.1007/s10554-013-0290-y

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