Prognostic role of transesophageal echocardiography in acute type A aortic dissection
Massachusetts General Hospital, Boston, Massachusetts, United States American heart journal
(Impact Factor: 4.46).
06/2007; 153(6):1013-20. DOI: 10.1016/j.ahj.2007.03.006
Acute type A aortic dissection (AAD) remains a highly lethal entity for which emergent surgical correction is standard care. Prior studies have identified specific clinical findings as being predictive of outcome. The prognostic significance of specific findings on imaging studies is less well described. We sought to identify the prognostic value of transesophageal echocardiography (TEE) in medically and surgically treated patients with AAD.
We studied 522 AAD patients enrolled over 6 years in the International Registry of Acute Aortic Dissection who underwent TEE. Multivariate analysis identified independent associations of inhospital mortality, first using clinical variables (model 1), after which TEE data were added to build a final model (model 2).
Inhospital mortality was 28.7%. Transesophageal echocardiographic evidences of pericardial effusion (P = .04), tamponade (P < .01), periaortic hematoma (P = .02), and patent false lumen (P = .08) were more frequent in nonsurvivors. Dilated ascending aorta (P = .03), dissection localized to the ascending aorta (P = .02), and thrombosed false lumen (P = .08) were less common in nonsurvivors. Model 1 identified age > or = 70 years, any pulse deficit, renal failure, and hypotension/shock as independent predictors of death. Model 2 identified dissection flap confined to ascending aorta (odds ratio 0.2, 95% CI 0.1-0.6) and complete thrombosis of false lumen (odds ratio 0.15, 95% CI 0.03-0.86) as protective. In the medically treated group, mortality was 31% for subjects with a partially or completely thrombosed false lumen versus 66% in the presence of a patent false lumen.
Transesophageal echocardiography provides prognostic information in AAD beyond that provided by clinical risk variables.
Available from: Birgit Assmus
- "In our case, echocardiography detected the widened ascending aorta. The accuracy of TEE in imaging intimal membranes for signs of aortic dissection has been reported to be 90% . Limitations of TEE exist with respect to the visualization of the distal ascending aorta and the aortic arch, where CT or MRI scans should be used. "
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ABSTRACT: We present the case of a 69-year-old female surviving an extensive dissecting thoracic aortic aneurysm. Due to the initial presentation with angina and epigastric pain the first working diagnosis was acute coronary syndrome. However, on transthoracic and transesophageal echocardiography (TEE), the dissecting aneurysm (type Stanford A) could be detected. Our article stresses the importance of imaging for the rapid and accurate diagnosis of thoracic aortic aneurysms with dissection. In our case, TEE detected the intimal flap separating true and false lumen, and the consecutive hemodynamically relevant aortic valve regurgitation, in addition to the aneurysm extent. The patient underwent surgical repair with aortic arch replacement and recovered without sequelae.
Available from: Dan Gilon
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ABSTRACT: The role of echocardiography in acute aortic syndrome has changed significantly in recent years. With the introduction of
harmonic imaging, transthoracic echocardiography has yielded substantial improvements in diagnosing aortic dissection, mainly
in the ascending aorta, and it provides accurate information for aortic insufficiency quantification, pericardial effusion,
and assessment of segmental alterations in ventricular contractility. Transesophageal echocardiography offers considerable
advantages in diagnosing acute aortic syndrome, because it permits excellent visualization of the intimal flap and the intramural
hematoma. The technique offers sufficient information to directly indicate surgery and is superior to other imaging techniques
for locating entry tears and analyzing aortic regurgitation mechanisms. In cases of definitive diagnosis by CT, transesophageal
echocardiography should be performed before surgical or endovascular treatment to provide essential information to allow development
of an appropriate therapeutic strategy.
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