![]() ![]() ![]() However, adequate sedation with strict blood pressure control is mandatory. Although isolated cases of aortic rupture during the procedure have been reported, the incidence in prospective series is very low, being more related to the intrinsic risk of the disease than the procedure itself, as these events also occur during CT or MRI. However, TEE is semi-invasive and requires sedation and may cause a rise in systemic pressure from retching and gagging. Several studies have demonstrated the accuracy of TEE in the diagnosis of aortic dissection with sensitivity of 86–100%, specificity 90–100% and a negative predictive value of 86–100% ( 15, 16). TEE permits identification of the intimal flap in most type A dissections ( Fig. The proximity of the oesophagus to the aorta, without interference from the chest wall or lung, permits high-quality images to be obtained. TEE is currently considered one of the reference techniques in aortic dissection diagnosis ( 7, 8, 13). ![]() Several boluses should be injected to obtain complete information on the ascending aorta, arch, proximal descending aorta and abdominal aorta, using similar windows to conventional echocardiographic studies. As specified in a previous publication ( 12), the mechanical index should to set between 0.6 and 0.9 to optimise contrast enhancement visualisation in the aorta. Furthermore, the contrast provides little for the diagnosis of intramural aortic haematoma therefore, if the suspicion is high, the practice of CT should be indicated. However, a negative TTE does not rule out aortic dissection, and other imaging techniques must be considered. Given its availability and additional information on cardiac condition, contrast TTE may be used as the initial imaging modality in the emergency setting when TTE information is not definitive. Ĭontrast TTE increases sensitivity and specificity for type A aortic dissection to 93 and 97% respectively, which is similar to TEE in the diagnosis of type A aortic dissection, although it is limited in type B involvement (sensitivity 84% and specificity 94%), mainly in the presence of non-extended dissection ( 12) ( Fig. ![]() Type A aortic dissection diagnosed by TTE. 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. Currently, TEE tends to be carried out in the operating theatre immediately before surgical or endovascular therapy and in monitoring their results. The best imaging strategy for appropriately diagnosing and assessing AAS is to combine CT, mainly ECG-gated contrast-enhanced CT, and TTE. Although computed tomography (CT) is the most used imaging technique in the diagnosis of AAS, echocardiography offers complementary information relevant for its management. TEE identifies the location and size of the entry tear, secondary communications, true lumen compression and the dynamic flow pattern of false lumen. 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 allows high-quality images in thoracic aorta. Should AAS be suspected, contrast administration is recommended when images are not definitive. TTE should be the first imaging technique to evaluate patients with thoracic pain in the emergency room. Both transthoracic (TTE) and transoesophageal echocardiography (TEE) are useful in the diagnosis of AAS. Since mortality from AAS is high, a prompt and accurate diagnosis using imaging techniques is paramount. 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. ![]()
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