Editorial: A better echocardiographic view to aortic dissection

European Heart Journal (Impact Factor: 15.2). 02/2010; 31(4):398-400. DOI: 10.1093/eurheartj/ehp404
Source: PubMed
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Available from: Rolf Alexander Jánosi, Jan 15, 2015
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    ABSTRACT: Acute aortic syndrome (AAS) comprises a variety of pathologically distinct life-threatening conditions such as aortic dissection, intramural hematoma (IMH) of the aorta, penetrating aortic ulcer (PAU), traumatic transection as well as symptomatic aortic aneurysm. Patients presenting with AAS require immediate diagnosis in order to rapidly initiate adequate therapeutic measures. Echocardiography is a rapidly available imaging technique which detects AAS with high sensitivity and specificity. Compared to computed tomography (CT) and magnetic resonance imaging (MRI), echocardiography allows emergency examination of unstable patients at bedside or even directly in the operating room. Transthoracic echocardiography (TTE) may be used initially in the emergency setting to gain information about left ventricular function as well as the presence of aortic regurgitation and pericardial effusion, but has only limited diagnostic accuracy for diagnosing AAS. Transoesophageal echocardiography (TOE) is used to directly visualise the aortic pathology in both the ascending and descending aorta. This article reviews the role of echocardiography in the emergency assessment of patients presenting with acute aortic syndrome.
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    ABSTRACT: The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by cardiac multislice CT and cardiac magnetic resonance. However, the new radiological techniques that have helped to reduce radiation exposure to patients and that have improved image acquisition could restore CT to the heart of general cardiac diagnosis. At the moment, it is not possible to displace the echocardiography from its central role in cardiac imaging. This article contains a review of the most important publications on echocardiography, magnetic resonance imaging and cardiac CT that have appeared recently in cardiology journals, mainly during 2010.
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    ABSTRACT: Malperfusion of the thoracoabdominal aorta and its side branches is a common complication of aortic dissection, often proving fatal. Vital organ malperfusion accompanying acute aortic dissection is a major cause of mortality and morbidity and requires timely reperfusion of the ischemic organs as well as adequate management of the aortic dissection. Ischemic damage to vital organs supplied by the thoracoabdominal aorta greatly increases the overall risk of aortic dissection. As initial symptoms may be subtle, malperfusion tends to be recognized late, and therefore accounts for a considerable percentage of fatalities.Effective reperfusion is not readily achieved by central aortic surgery alone in a certain number of patients. Various strategies have been used, including entry closure by central aortic surgery or stent grafting, surgical or catheter fenestration, bypass grafting and percutaneous stenting.Endovascular bare-metal stent placement is an attractive and promising treatment option since it is readily available, is less invasive and presents fewer risks to the patient.
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