A PROSPECTIVE ANALYSIS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF TRAUMATIC DISRUPTION OF THE AORTA

Objective: Recently, transesophageal echocardiography (TEE) has been p roposed as the standard for the diagnosis of traumatic disruption of t he aorta (TDA), replacing aortography. The purpose of this study was t o evaluate the accuracy and practicality of TEE in the diagnosis of TD A. Design: Prospective clinical trial. Materials and Methods: Patients with blunt trauma admitted with a suspected diagnosis of TDA were eva luated with TEE and aortography. Measurements and Main Results: Thirty -four patients were evaluated with TEE and aortography. TEE was unsucc essful in five patients (15%). Of the remaining 29 patients, TEE resul ts were true-positive in four and true-negative in 20. TEE results wer e false-positive in two patients, and three injuries were missed (two were proximal to the left subclavian artery, and one was a localized a ortic disruption). Sensitivity and specificity of TEE were 57% and 91% , respectively, compared with aortography, for which sensitivity was 8 9% and specificity was 100%. Conclusion: Although the use of TEE in th e diagnosis of TDA has several advantages, it is not more accurate tha n aortography. TEE should not replace aortography as the standard for the diagnosis of TDA.