Bedside Transthoracic Echo for Proximal Aortic Dissection
Bedside Transthoracic Echo for Proximal Aortic Dissection
Study objective The purpose of the present study was to establish the accuracy of transthoracic echocardiography (TTE) in diagnosis of acute type A aortic dissection in comparison to computed tomography (CT), with reference to the intraoperative image.
Methods The retrospective analysis included 178 patients referred to the cardiac surgery unit in our center due to acute type A dissection between 01-01-2008 and 31-12-2013, who underwent both TTE and CT. Intraoperative image was considered as a reference.
Results Statistical analysis did not show any significant differences between computed tomography and echocardiography in the detection of the proximal aortic dissection. In patients with aortic valve abnormalities, procedure of choice was replacement by a composite graft (77,59%), whereas patients with a normal image of aortic valve were more likely to have the valve sparing procedure (50,88%). The R-Spearman statistics shows a strong positive correlation between maximum diameter of ascending aorta measured by TTE and CT (cc 0.869) and TTE and intraoperative measurement (cc 0.844).
Conclusion Our data confirm that transthoracic echocardiography is a reliable method for diagnosis of proximal aortic dissection. TTE provides a reliable value of maximum diameter of the ascending aorta in comparison to both CT and direct intraoperative measurement. Moreover, transthoracic echocardiography gives the additional information that influences the operative technique of choice and identifies the high-risk patients (cardiac tamponade, severe aortic dilatation, severe aortic regurgitation). Our retrospective analysis confirms the pivotal role of TTE in the evaluation of the patients with suspected proximal aortic dissection in emergency room setting.
Acute aortic dissection is a life-threatening condition that requires a prompt diagnosis and definite management. Acute thoracic aortic dissection involving the ascending aorta (type A by Stanford classification, proximal aortic dissection) is an undoubtful indication for emergent surgical intervention. The well documented mortality rise of 1–2% for each hour following type A dissection highlights the importance of the rapid, easily accessible, noninvasive diagnostic method. Computed tomography (CT) is considered a gold standard that enables to visualize the entire aorta and to distinguish among the different types of acute aortic syndromes. However, this technique is not always available, requires transferring the patient to the CT lab and often generates a significant delay in treatment. Transthoracic echocardiography (TTE) given its rapidity, availability, portability and safety seems an ideal imaging technique for the initial evaluation of the patients with suspected proximal aortic dissection.
The purpose of our present study was to assess the accuracy of TTE in diagnosis of acute type A aortic dissection in comparison to computed tomography, with reference to the intraoperative image (actual surgical findings).
Abstract and Introduction
Abstract
Study objective The purpose of the present study was to establish the accuracy of transthoracic echocardiography (TTE) in diagnosis of acute type A aortic dissection in comparison to computed tomography (CT), with reference to the intraoperative image.
Methods The retrospective analysis included 178 patients referred to the cardiac surgery unit in our center due to acute type A dissection between 01-01-2008 and 31-12-2013, who underwent both TTE and CT. Intraoperative image was considered as a reference.
Results Statistical analysis did not show any significant differences between computed tomography and echocardiography in the detection of the proximal aortic dissection. In patients with aortic valve abnormalities, procedure of choice was replacement by a composite graft (77,59%), whereas patients with a normal image of aortic valve were more likely to have the valve sparing procedure (50,88%). The R-Spearman statistics shows a strong positive correlation between maximum diameter of ascending aorta measured by TTE and CT (cc 0.869) and TTE and intraoperative measurement (cc 0.844).
Conclusion Our data confirm that transthoracic echocardiography is a reliable method for diagnosis of proximal aortic dissection. TTE provides a reliable value of maximum diameter of the ascending aorta in comparison to both CT and direct intraoperative measurement. Moreover, transthoracic echocardiography gives the additional information that influences the operative technique of choice and identifies the high-risk patients (cardiac tamponade, severe aortic dilatation, severe aortic regurgitation). Our retrospective analysis confirms the pivotal role of TTE in the evaluation of the patients with suspected proximal aortic dissection in emergency room setting.
Introduction
Acute aortic dissection is a life-threatening condition that requires a prompt diagnosis and definite management. Acute thoracic aortic dissection involving the ascending aorta (type A by Stanford classification, proximal aortic dissection) is an undoubtful indication for emergent surgical intervention. The well documented mortality rise of 1–2% for each hour following type A dissection highlights the importance of the rapid, easily accessible, noninvasive diagnostic method. Computed tomography (CT) is considered a gold standard that enables to visualize the entire aorta and to distinguish among the different types of acute aortic syndromes. However, this technique is not always available, requires transferring the patient to the CT lab and often generates a significant delay in treatment. Transthoracic echocardiography (TTE) given its rapidity, availability, portability and safety seems an ideal imaging technique for the initial evaluation of the patients with suspected proximal aortic dissection.
The purpose of our present study was to assess the accuracy of TTE in diagnosis of acute type A aortic dissection in comparison to computed tomography, with reference to the intraoperative image (actual surgical findings).
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