TRANSESOPHAGEAL ECHOCARDIOGRAPHY AS THE SOLE DIAGNOSTIC INVESTIGATIONIN PATIENTS WITH SUSPECTED THORACIC AORTIC DISSECTION

Objectives-To assess the value and limitations of using transoesophage al echocardiography as the sole diagnostic test in patients with suspe cted thoracic aortic dissection. Design-Retrospective data review over a two year period. Setting-A regional cardiothoracic centre. Patients -Data were compiled from admission records, surgical records, and list s of patients undergoing diagnostic investigations in the hospital. Pa tient's notes were used to identify presentation, management, and outc ome. Interventions-Patients were managed according to the policy of ou r unit, which is to treat patients with dissection affecting the ascen ding aorta by an operation. Patients with uncomplicated dissection spa ring the ascending aorta are initially managed medically. Main outcome measures-In hospital and two year follow up of patients who were inve stigated by transoesophageal echocardiography alone. Results-Of 48 pat ients referred, 45 underwent transoesophageal echocardiography. Dissec tion was confirmed in 22 patients. Transoesophageal echocardiography s howed the proximal extent of the dissection in 21/22 (96%) and only on e patient required a further diagnostic investigation. Ten patients wi th dissection of the ascending aorta underwent graft replacement of th e ascending aorta; operative mortality was 10% and their two year surv ival was 80%. Of the eight patients with dissection of the descending aorta, six were discharged home, and five were alive at two years. No patient without evidence of dissection on their initial transoesophage al echocardiographic examination required re-investigation into possib le dissection in the two years after discharge. Conclusions-In patient s with suspected thoracic dissection transoesophageal echocardiography rapidly and safely gives all the necessary diagnostic information. Fu rther investigations, including coronary angiography, before surgery a re unnecessary.