CT recognition of acute aortic dissection

Oudkerk, M.; Overbosch, E. H.; Dee, Paul M.

doi:10.2214/ajr.141.4.671

Cited by 46 publications

(7 citation statements)

References 11 publications

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“…Thrombus Formation Combining the information obtained by transesophageal two-dimensional echocardiography and color-coded Doppler, patients (patients 1, 4, 11, 15) with remaining large communications had laminar flow within the false lumen and no or only localized thrombus formation. However, in patients where the leading intimal tear had been closed during surgery (patients 2, 3, 5) or in those with only small communications (patients 11,12,16,17,18) in the descending aorta, slowly circulating flow within the false lumen and extensive and progressive thrombus formation was observed. Thrombus formation in the false lumen was not detected by conventional echocardiography.…”

Section: Intimal Tearsmentioning

confidence: 99%

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Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

et al. 1989

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Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas colorcoded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20%o from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the aorta (two of 18 patients), mediastinal hematoma (one of 18 patients), or aortic regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal twodimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up. (Circulation 1989;80:24-33 Transesophageal echocardiography overcomes these methodologic limitations and is of great diagnostic value because of high-quality cross-sectional images of the ascending and descending thoracic aorta even in patients in shock or on mechanical ventilation.23-30 Surgery without further diagnostic investigation has been performed successfully in emergency cases.30 In combination with color-coded Doppler flow imaging, which superimposes flow information

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Section: Intimal Tearsmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17][18][19][20] Echocardiography is the method of choice for diagnosis of aortic dissection because it is less invasive and less expensive than other methods. Transthoracic echocardiography is less reliable in patients with obesity, pulmonary emphysema, or thorax deformation.…”

mentioning

confidence: 99%

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

et al. 1989

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“…The early reliance on invasive, time-consuming, risky aortography was eventually replaced by less invasive, faster, and more convenient diagnostic imaging methods including the current main-stay, CTA (39)(40)(41). In these early days, the sensitivity and specificity of early computed tomography (CT) in detecting thoracic aortic dissection lagged behind that of other imaging modalities such as TEE and magnetic resonance imaging (MRI) (42).…”

Section: Type B or Not Type B? That Is The Questionmentioning

confidence: 99%

Evolution of surgical therapy for Stanford acute type A aortic dissection

Chiu¹,

Miller²

2016

ASVIDE

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Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small?The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

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“…Th e o rigins of the ao rtic arch and coronary arteries are not imaged directly. CT of the ao rta always requires injectio n of contrast medium (3,11,15,17).…”

Section: Computer Tomographymentioning

confidence: 99%

Radiological Diagnosis of the Thoracic Aortic Aneurysm

Harder

Nicolas²,

Steudel³

et al. 1987

Thorac cardiovasc Surg

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Indications and the diagnostic value of radiological investigation methods in thoracic aortoaneurysm are reported. The suspected diagnosis can already be made on the basis of conventional x-ray examination of the thorax. Computer tomography (CT) with i.v. administration of contrast medium allows unequivocal identification of a mediastinal space occupation as an aneurysm. However, preoperative angiography is indispensable in many cases for appraisal of the vessel origins. Depending on the condition to be investigated, digital subtraction angiography (DSA) which is carried out with i.v. or i.a. injection of contrast medium has replaced conventional angiography here. Nuclear magnetic resonance tomography has only minor importance so far despite the good imaging of the aorta.

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CT recognition of acute aortic dissection

Cited by 46 publications

References 11 publications

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Evolution of surgical therapy for Stanford acute type A aortic dissection

Radiological Diagnosis of the Thoracic Aortic Aneurysm

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