Role of Transesophageal Echocardiography in the Management of Acute Aortic Dissection.

DOI 16 References Open Access
  • Orihashi Kazumasa
    First Department of Surgery, Hiroshima University School of Medicine
  • Sueda Taijiro
    First Department of Surgery, Hiroshima University School of Medicine
  • Watari Masanobu
    First Department of Surgery, Hiroshima University School of Medicine
  • Okada Kenji
    First Department of Surgery, Hiroshima University School of Medicine
  • Ishii Osamu
    First Department of Surgery, Hiroshima University School of Medicine

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  • 急性大動脈解離の管理における経食道心エコー法の役割

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Reasons for failing to save acute aortic dissection (AAD) patients include critical, sudden complication associated with AAD and limited examination feasible in critical condition. Computed tomography and angiography are occasionally unfeasible. Considering it most important to comprehend the pathology at bedside in real time, we introduced transesophageal echocardiography (TEE) to manage AAD. Subjects were 27 consecutive patients--15 men 35 to 68 years old and 12 women 51 to 84 years old. A biplace TEE (Hitachi, Co., Tokyo) was used. TEE included: 1) diagnosis of dissection; 2) extent of dissection; 3) site of entry; 4) diagnosis of complications (cardiac workup tamponade, hemothorax, etc); 5) thrombosis in false lumen; 6) perfusion in branch arteries; 7) intraoperative changes in pathology; and 8) navigation of treatment. Surgical intervention was indicated in 24 and conservative theraphy in 3. We had 3 operative deaths and overall survival of 88.9%. The occurrence of subclinical changes that could be diagnosed only with TEE was not rare. Information provided by TEE has enabled definite diagnosis, elimination of possible pathologies, comprehension of altered conditions, monitoring of intraluminal events, guidance of therapeutic procedures, and immediate assessment of surgical procedures in the operating room. TEE was advantageous in obtaining abundant information less invasively at bedside and in real time and in using it as an eye in various procedures. Disadvantages of TEE include semiinvasiveness in awake patients, presence of a learning curve, and possible damage to esophageal mucosa (although none was encountered in this series). Although arch branch vessels and abdominal visceral arteries were “blind zone” for TEE, we developed techniques for visualizing these vessels, enabling us to recognize extended dissection into these arteries and perfusion in them. While computed tomography is still the gold standard in diagnosing AAD, useful information is provided by using TEE complimentarily. We concluded that TEE is useful for recognizing pathologies and dealing with them in patients with unusual clinical courses of AAD.

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