AMBULATORY FOLLOW-UP OF AORTIC DISSECTION - COMPARISON BETWEEN COMPUTED-TOMOGRAPHY AND BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Aim of the study was to assess the relative usefulness of transesophag eal echocardiography (TEE) and X-ray computed tomography (CT) in the f ollow-up of patients who survived an aortic dissection. Materials and Methods. We evaluated 44 patients (age = 57 +/- 12 years) with treated aortic dissection: 14 had a De Bakey type I, 20 a type II and 1 patie nt a type III dissection treated surgically; 1 patient had a type I, 1 a type II and 7 a type III dissection treated medically. All entered an outpatient follow-up program with serial evaluations at 1, 6 and 12 months after initial diagnosis by dual noninvasive imaging protocol. A contrast-enhanced CT scan and a TEE with biplane probe were performe d on the same day and in random order. Results. A total of 252 evaluat ions with both CT and TEE were considered. A completely normal study w as found in 45 TEE and 48 CT evaluations. The following abnormal findi ngs could be documented by one or both techniques: thrombus in the fal se lumen (TEE: n = 48; CT: n = 45 evaluations); intimal flap (TEE and CT: n = 68); aortic dilatation (TEE and CT: n = 15); pericardial effus ion (TEE and CT: n = 3); aortic pseudoaneurysm (TEE: n = 2; CT: n = 3) ; isthmic coarctation (TEE and CT: n = 1). Regarding the presence or a bsence of these abnormalities, which are within the diagnostic domain of both imaging techniques, the results were fully concordant in 245 s tudies, and discordant in 7, with an overall agreement of 97%. In addi tion, some abnormal findings could be detected by TEE only: aortic ins ufficiency (n = 36); intimal tear (n = 25); spontaneous echocontrast e ffect in the false lumen (n = 39 evaluations). Other abnormal findings could be detected by CT only: a pleural effusion in 4, a truncus anon ymous dissection in 1, a pseudoaneurysm due to suture dehiscence of th e distal anastomosis of the ascending aorta in 1 evaluation (which yie lded ambiguous results by TEE, with turbulent flow departing from the graft). Conclusion. Both CT and TEE are atraumatic, safe and accurate techniques for serial follow-up imaging of patients treated for aortic dissection. Information provided by CT is largely redundant, rather t han additive, to that provided by TEE. The latter should be probably p referred for shorter imaging time, accuracy and convenience, although CT might still play a role in selected cases of ambiguous TEE results.