COMPARATIVE DIAGNOSTIC-VALUE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND RETROGRADE AORTOGRAPHY IN THE EVALUATION OF THORACIC AORTIC DISSECTION

The aim of this study was to assess the comparative diagnostic value o f transesophageal echocardiography (TEE) and retrograde aortography fo r morphologic evaluation and anatomic mapping of aortic dissection. Se venty patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, find ings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was signif icantly shorter for TEE (9 +/- 6 vs 48 +/- 25 minutes; p <0.001). For the detection of aortic dissection, aortography showed lower sensitivi ty (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; bot h trends did not reach statistical significance) due mostly to the ina bility to identify noncommunicating dissection (dissection without int imal tears). For the epiphenomena of aortic dissection, aortography wa s significantly more accurate (97.2% vs 78%; p <0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus form ation (90% vs 65%; p <0.05). There was no significant difference betwe en aortography and TEE with regard to assessing secondary tears, aorti c regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for gu ided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injecti on, and provides accurate diagnosis in a short time at the bedside.