Incremental Value of Live/Real Time Three‐Dimensional Transesophageal Echocardiography over the Two‐Dimensional Technique in the Assessment of Aortic Aneurysm and Dissection

Abstract

We compared findings from intraoperative live/real time three-dimensional transesophageal echocardiography (3DTEE) and two-dimensional transesophageal echocardiography (2DTEE) with surgery in 67 patients having aortic aneurysm and/or aortic dissection. Of these, 20 patients had aortic aneurysm without dissection, 21 aortic aneurysm and dissection, and 26 aortic dissection without aneurysm. 3DTEE diagnosed the type and location of aneurysm correctly in all patients unlike 2DTEE, which missed an aneurysm in one case. There were four cases of aortic aneurysm rupture. Three of them were diagnosed by 3DTEE but only one by 2DTEE, and one missed by both techniques. The mouth of saccular aneurysm, site of aortic aneurysm rupture, and communication sites between perfusing and nonperfusing lumens of aortic dissection could be viewed en face only with 3DTEE, enabling comprehensive measurements of their area and dimensions as well as increasing the confidence level of their diagnosis. In all patients with aortic dissection, 3DTEE enabled a more confident diagnosis of dissection because the dissection flap when viewed en face presented as a sheet of tissue rather than a linear echo seen on 2DTEE which can be confused with an artifact. 2DTEE missed dissection in one patient. In six cases the dissection flap involved the right coronary artery orifice by 3DTEE and surgery. These were missed by 2DTEE. Aortic regurgitation severity was more comprehensively assessed by 3DTEE than 2DTEE. Aneurysm size by 3DTEE correlated well with 2DTEE and surgery/computed tomography scan. In conclusion, 3DTEE provides incremental information over 2DTEE in patients with aortic aneurysm and dissection.

Ascending Aortic Diameters in Congenital Aortic Stenosis: Cardiac Magnetic Resonance versus Transthoracic Echocardiography

“…For this young asymptomatic patient population computed tomography or transesophageal echocardiography is generally not considered first choice because of the disadvantage of respective radiation exposure and invasiveness, but there might be a role for three‐dimensional TTE …”

“…For this young asymptomatic patient population computed tomography or transesophageal echocardiography is generally not considered first choice because of the disadvantage of respective radiation exposure and invasiveness, but there might be a role for three-dimensional TTE. 20,21 Because of certain disadvantages of CMR (contraindicated use in patients with claustro-phobia and metallic implants, prolonged duration of imaging acquisition, higher costs, and often limited availability), echocardiography is often the most pragmatic choice in routine clinical practice. When availability of CMR is limited, we advise to perform both TTE and CMR at baseline and assess agreement between both techniques in respect to aortic diameter measurements at all 4 levels in the individual patient.…”

A Case Report of Three Dimensional Transthoracic Echocardiographic View of Acute Proximal Type Aortic Dissection

“…5 In order not to waste time at bedside, TTE may be applied as it's non-invasive and easily performed. 3DTTE may be preferred in available clinics as it detects exact location of the rupture site and displays the dissection flap like a sheet in a 3D view rather than just a line in 2D view.…”

Role of 3D Echocardiography in Cardiac Surgery: Strengths and Limitations

“…The linear image of the dissection membrane can be mistaken for an artifact in a 2D examination. The involvement of the right coronary artery ostium in aortic dissections is more accurately diagnosed by 3D TEE [ 48 ].…”