HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Simon, P. Articles by Mohl, W. Search for Related Content PubMed PubMed Citation Articles by Simon, P. Articles by Mohl, W.

The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1113-1117, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection

P Simon, AN Owen, M Havel, R Moidl, M Hiesmayr, E Wolner and W Mohl
II Surgical Clinic, University of Vienna, Austria.

The diagnostic accuracy and benefit of transesophageal echocardiography were investigated in 32 patients with suspected aortic dissection. Results of transesophageal echocardiography were compared with surgical assessment. The Stanford classification was used for differentiation of dissection type. Examination time was 5 to 15 minutes. Twenty-eight patients were correctly identified to have aortic dissection; four patients had nondissecting aneurysms of the ascending aorta. Both sensitivity and specificity for detection of aortic dissection were 100%. Type of dissection was misdiagnosed in one patient. Classification of dissection type was correct in 96%. The primary entry site was correctly identified in 25 patients (89%). Aortic regurgitation was found in 57% of patients. Pericardial effusion was detected in 21%, with tamponade in one patient. Myocardial infarction was suggested by transesophageal echocardiography in 7%, and 14% had significantly reduced left ventricular function. Eight patients underwent operation based on transesophageal echocardiography alone. Intraoperative transesophageal echocardiography, performed in 20 patients, verified retrograde flow in the true lumen after femoral cannulation. Transesophageal echocardiography documented postrepair persistence of the intimal flap in aortic segments that were not operated on in all patients. Secondary tears and flow in the false lumen were detected in 35% of patients. We conclude that transesophageal echocardiography allows expedient and accurate diagnosis and classification of aortic dissection, and we recommend it as the primary bedside diagnostic modality. It can especially identify patients requiring surgical intervention without further delay caused by other diagnostic procedures.

This article has been cited by other articles:

				T. Shiga, Z. Wajima, C. C. Apfel, T. Inoue, and Y. Ohe Diagnostic Accuracy of Transesophageal Echocardiography, Helical Computed Tomography, and Magnetic Resonance Imaging for Suspected Thoracic Aortic Dissection: Systematic Review and Meta-analysis. Arch Intern Med, July 10, 2006; 166(13): 1350 - 1356. [Abstract] [Full Text] [PDF]

				K. Orihashi, T. Sueda, K. Okada, and K. Imai Perioperative diagnosis of mesenteric ischemia in acute aortic dissection by transesophageal echocardiography Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 871 - 876. [Abstract] [Full Text] [PDF]

				E. A. Hessel Bypass Techniques for Descending Thoracic Aortic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 293 - 320. [Abstract] [PDF]

				K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino Preoperative risk factors for hospital mortality in acute type A aortic dissection Ann. Thorac. Surg., April 1, 2001; 71(4): 1239 - 1243. [Abstract] [Full Text] [PDF]

				H. D. Movsowitz, R. A. Levine, A. D. Hilgenberg, and E. M. Isselbacher Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair J. Am. Coll. Cardiol., September 1, 2000; 36(3): 884 - 890. [Abstract] [Full Text] [PDF]

				H. J. Willens and K. M. Kessler Transesophageal Echocardiography in the Diagnosis of Diseases of the Thoracic Aorta* : Part 1. Aortic Dissection, Aortic Intramural Hematoma, and Penetrating Atherosclerotic Ulcer of the Aorta Chest, December 1, 1999; 116(6): 1772 - 1779. [Full Text] [PDF]

				P. Pugliese, R. Pessotto, F. Santini, G. Montalbano, G. B. Luciani, and A. Mazzucco Risk of late reoperations in patients with acute type A aortic dissection: impact of a more radical surgical approach Eur. J. Cardiothorac. Surg., May 1, 1999; 13(5): 576 - 581. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, B. W. Lytle, R. J. Kaplon, F. P. Casselman, E. H. Blackstone, and D. M. Cosgrove DISSECTION OF THE ASCENDING AORTA AFTER PREVIOUS CARDIAC SURGERY: DIFFERENCES IN PRESENTATION AND MANAGEMENT J. Thorac. Cardiovasc. Surg., February 1, 1999; 117(2): 252 - 260. [Abstract] [Full Text] [PDF]

				N. Madhu Sankar, K. Lai, K. Harrison, P. Klineberg, and W. Meldrum Hanna Intraoperative Dissection of Aorta and Successful Repair Asian Cardiovasc Thorac Ann, March 1, 1998; 6(1): 66 - 67. [Abstract] [Full Text] [PDF]

				D. Moskowitz and D. L. Reich Aortic Dissection: Is Transesophageal Echocardiography the Diagnostic Method of Choice? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 71 - 80. [PDF]

				L. K. von Segesser, E. Lorenzetti, M. Lachat, U. Niederhauser, M. Schonbeck, P. R. Vogt, and M. I. Turina AORTIC VALVE PRESERVATION IN ACUTE TYPE A DISSECTION: IS IT SOUND? J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 381 - 391. [Abstract] [Full Text]

				R. J. Rizzo, S. F. Aranki, L. Aklog, G. S. Couper, D. H. Adams, J. J. Collins Jr., N. M. Kinchla, E. N. Allred, and L. H. Cohn Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection: Improved survival with less angiography J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 567 - 575. [Abstract] [Full Text]

				J. E. Cigarroa, E. M. Isselbacher, R. W. DeSanctis, and K. A. Eagle Diagnostic Imaging in the Evaluation of Suspected Aortic Dissection -- Old Standards and New Directions N. Engl. J. Med., January 7, 1993; 328(1): 35 - 43. [Full Text]