The current role of echocardiography in acute aortic syndrome

Abstract

Acute aortic syndrome (AAS) comprises a range of interrelated conditions caused by disruption of the medial layer of the aortic wall, including aortic dissection, intramural haematoma and penetrating aortic ulcer. Since mortality from AAS is high, a prompt and accurate diagnosis using imaging techniques is paramount. Both transthoracic (TTE) and transoesophageal echocardiography (TEE) are useful in the diagnosis of AAS. TTE should be the first imaging technique to evaluate patients with thoracic pain in the emergency room. Should AAS be suspected, contrast administration is recommended when images are not definitive. TEE allows high-quality images in thoracic aorta. The main drawback of this technique is that it is semi-invasive and the presence of a blind area that limits visualisation of the distal ascending aorta near. TEE identifies the location and size of the entry tear, secondary communications, true lumen compression and the dynamic flow pattern of false lumen. Although computed tomography (CT) is the most used imaging technique in the diagnosis of AAS, echocardiography offers complementary information relevant for its management. The best imaging strategy for appropriately diagnosing and assessing AAS is to combine CT, mainly ECG-gated contrast-enhanced CT, and TTE. Currently, TEE tends to be carried out in the operating theatre immediately before surgical or endovascular therapy and in monitoring their results. The aims of this review are to establish the current role of echocardiography in the diagnosis and management of AAS based on its advantages and limitations.

Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection

“…It is often difficult to identify the location of the intimal tear due to a remarkable motion artifact of the ascending aorta on non-ECG-gated CTA [ 2 ]. Transthoracic and transesophageal echocardiographies may be used together, but CTA is frequently performed, so it is necessary to improve the image quality of CTA [ 1 ].…”

“…Clear imaging of the affected area is required, and transesophageal and transthoracic echocardiographies are often performed, which are quick and does not expose the patient to radiation [ 1 ]. Computed tomography angiography (CTA) is almost simple and suitable for screening for other diseases throughout the body and is mostly performed; however, this is often difficult due to a remarkable motion artifact of the ascending aorta on non-electrocardiogram (ECG)-gated CTA [ 2 ].…”

<p>Diagnosing Aortic Intramural Hematoma: Current Perspectives</p>

“…3,45 In some cases, pericardial effusion is a sign of aortic rupture, whereas in some others it resulted from blood extravasation through an irritated adventitia. 46 In any case, the presence of pericardial effusion in patients with AIH is associated with a worse prognosis. 1,3,6 TTE also allows evaluation of the aortic valve and aortic regurgitation (Figure 1B).…”

“…However, some complications of AIH, as pericardial effusion, are excellently detected with TTE. 3,41,44,46,47 Pericardial effusion appears in up to 60% of patients with type A AIH. 3,45 In some cases, pericardial effusion is a sign of aortic rupture, whereas in some others it resulted from blood extravasation through an irritated adventitia.…”

“…1,3,6 TTE also allows evaluation of the aortic valve and aortic regurgitation (Figure 1B). 13,42,44,46 Thirtyfive percent of patients with type A AIH have some grade of aortic regurgitation. 3 In such cases, the severity of the aortic regurgitation will have important implications on the surgical technique.…”