Usefulness of transesophageal echocardiography in the assessment of aorticdissection

The acute dissection of the ascending aorta requires prompt and reliable di agnosis to reduce the high risk of mortality; in addition, prognosis is inf luenced by longterm complications. The aim of this article is to discuss tr ansesophageal echocardiography (TEE) and (1) its diagnostic accuracy in the presurgical evaluation of patients, (2) its role in reducing time of diagn osis and surgery, and (3) its ability to reduce hospital mortality. TEE has also been tested as a screening method in the postsurgical follow-up of th ese patients. The retrospective investigation concerns a sample of 80 cases of acute dissection of the aorta, submitted for surgical intervention from April 1986 to February 1999. TEE has allowed a precise estimation of aorti c diameters and optimal visualization of intimal flap and tear entry with a fine distinction between true and false lumen. A direct comparison of the results of TEE and of transthoracic echocardiography has demonstrated that some elements (visualization of flap and diameters in descending aorta, sit es of entry and reentry, direction of let trough intimal tears, phasic inti mal flap movement, diastolic collapse of flap on the valvular plane, false lumen thrombosis, coronary involvement, intramural hematoma, and aortic fis suration) were identified only by TEE, whereas other additional diagnostic elements (cardiac tamponade, aortic valve insufficiency, left ventricular f unction) show a similar pattern of significance. Routine employment of this method has confirmed a reduction of hospitalization time (about 1.5 hours of waiting time), and hospital mortality has changed from 42.8% to 17.3%. I n the follow-up of patients operated on for aortic dissection, fundamental information may be obtained from TEE (assessment of the progression of thro mbosis in the false lumen with its complete obliteration and modifications in aortic diameter with a consequent, possible worsening of aortic valve in sufficiency). In conclusion, our study demonstrated that TEE may provide fa st and efficient detection of acute aortic dissection. In the postsurgical follow-up, TEE has confirmed detection of major complications that can infl uence long-term prognosis and may be proposed as a method with easy access- one that is repeatable and inexpensive for the screening of aortic dissecti on surgical patients. (C) 2000 by Excerpta Medica, Inc.