COMMUNICATING VERSUS NONCOMMUNICATING ACUTE THORACIC AORTIC DISSECTION - 2 CASE-REPORTS AND DIAGNOSTIC-VALUE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND ALTERNATIVE IMAGING MODALITIES

Two patients, with communicating and noncommunicating Stanford type A acute aortic dissection each, are reported with anatomic and hemodynam ic features diagnosed by single-plane transesophageal echocardiography (TEE) with color flow imaging. TEE demonstrated a communicating disse ction, more in detail than aortography and computed tomography, with a n intimal flap, the extent of dissection, the dissecting intimal flap prolapse through the aortic valve during diastole, flow patterns in th e true and false lumina, presence and absence of aortic valvular regur gitation, and absence of pericardial effusion. TEE showed the presence of a noncommunicating (variant) dissection, which was nondiagnostic b y magnetic resonance imaging and aortography before surgery, with intr amural thrombus (hematoma) formation and its extent and location, accu rate measurement of aortic wall thickness, and the presence of an inti mal flap or intramural blood flow. In addition, TEE also permitted eva luation of global and regional systolic performance. Therefore, TEE ca n be recommended as the first-line modality of choice for an early dia gnosis of an acute thoracic aortic dissection.