Aortic dissection echocardiography and ultrasound

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

The echocardiographic changes diagnostic of aortic dissection include Intimal flaps in the aorta obstruction of a false lumen, intimal calcification displacement toward the center of the lumen, separation of intimal layers from the thrombus, and shearing of different wall layers during aortic pulsation. The sensitivity and specificity of transthoracic echocardiography vary based on the type of dissection and are usually lower for the diagnosis of distally located aortic dissection. Echocardiography may also show severe pleural effusion, which is suggestive of the development of cardiac tamponade. Transesophageal echocardiography may be useful in the diagnosis of aortic dissection in patients in whom transthoracic echocardiography has limited efficacy. Prolapse of intimal flap through the aortic valve seen in transesophageal echocardiography is diagnostic of aortic dissection complicated by aortic regurgitation. Sensitivity is usually higher (99%). However, it has limited usage in the diagnosis of dissections involving the distal portion of ascending aorta.

Echocardiography

Transthoracic Echocardiography

The echocardiographic changes diagnostic of aortic dissection include:

• Intimal flaps in the aorta
• Obstruction of a false lumen
• Intimal calcification displacement toward the center of the lumen
• Separation of intimal layers from the thrombus
• Shearing of different wall layers during aortic pulsation

The sensitivity and specificity of transthoracic echocardiography vary based on the type of dissection and are usually lower for the diagnosis of distally located aortic dissection.
Echocardiography may also show severe pleural effusion, which is suggestive of the development of cardiac tamponade.

Transesophageal Echocardiography

Transesophageal echocardiography may be useful in the diagnosis of aortic dissection in patients in whom transthoracic echocardiography has limited efficacy.

• Prolapse of intimal flap through the aortic valve seen in transesophageal echocardiography is diagnostic of aortic dissection complicated by aortic regurgitation.
• Sensitivity is usually higher (99%). However, it has limited usage in the diagnosis of dissections involving the distal portion of ascending aorta.

Echocardiography Examples of Aortic Dissection

Echocardiogram of an aortic dissection

Echocardiogram of an aortic dissection

Aortic Dissection

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Aortic Dissection Type A

Example 1	{{#ev:googlevideo|-1580944144837691434}}	Example 2	{{#ev:googlevideo|-3610218405615821421}}
Example 3	{{#ev:googlevideo|-8461290621229660122}}	Example 4	{{#ev:googlevideo|-8561147882050584609}}
Example 5	{{#ev:googlevideo|2157100999251300976}}	Example 6	{{#ev:googlevideo|698950344523479477}}

Aortic Dissection Type B

Example 1	{{#ev:googlevideo|3238725821918795498}}	Example 2	{{#ev:googlevideo|197658671308723787}}

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)

Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection

Class I

"Initial recommended imaging study for the diagnosis of acute aortic syndrome is transthoracic echocardiography. (Level of Evidence: C)"

Class IIa

"In stable patients, transoesophageal echocardiography is the recommended imaging study. (Level of Evidence: C)"

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)

Screening Tests (DO NOT EDIT)

Class I

"1. Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening. (Level of Evidence: B)"

Determining the Presence and Progression of Thoracic Aortic Disease (DO NOT EDIT)

Class I

"1. Measurements of aortic diameter should be taken at reproducible anatomic landmarks, perpendicular to the axis of blood flow, and reported in a clear and consistent format. (Level of Evidence: C)"

"2. For measurements taken by echocardiography, the internal diameter should be measured perpendicular to the axis of blood flow. For aortic root measurements, the widest diameter, typically at the mid sinus level, should be used. (Level of Evidence: C)"

"3. Abnormalities of aortic morphology should be recognized and reported separately even when aortic diameters are within normal limits. (Level of Evidence: C)"