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Aortic dissection echocardiography

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Aortic dissection Microchapters

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Overview

Historical Perspective

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Pathophysiology

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Differentiating Aortic dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

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Management during Pregnancy

Case Studies

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

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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

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Transthoracic Echocardiography

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The echocardiographic changes diagnostic of aortic dissection include:[1][2][3][4]

  • 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

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Transesophageal echocardiography may be useful in the diagnosis of aortic dissection in patients in whom transthoracic echocardiography has limited efficacy.[5]

Echocardiography Examples of Aortic dissection

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Echocardiogram of an aortic dissection
Echocardiogram of an aortic dissection

Aortic Dissection

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Aortic Dissection Type A

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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

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

2022 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease [7]

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screening tests

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Class I
1.In patients with TAD who have a pathogenic/likely pathogenic variant, genetic testing of at-risk biological relatives (ie, cascade testing) is recommended. In family members who are found by genetic screening to have inherited the pathogenic/likely pathogenic variant, aortic imaging with TTE (if aortic root and ascending aorta are adequately visualized, otherwise with CT or MRI) is recommended.(Level of Evidence: B-NR)
Class IIa
In patients with a suspected AAS, TEE and MRI are reasonable alternatives for initial diagnostic imaging(Level of Evidence: C-LD)

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[5]

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Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection

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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)[8]

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Screening Tests (DO NOT EDIT)[8]

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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)[8]

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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)"

References

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  1. ↑ Mintz GS, Kotler MN, Segal BL, Parry WR (August 1979). "Two dimensional echocardiographic recognition of the descending thoracic aorta". Am. J. Cardiol. 44 (2): 232–8. doi:10.1016/0002-9149(79)90310-2. PMID 463760.
  2. ↑ Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller FA, Stanson AW, Sinak LJ, Oh JK, Seward JB (1989). "Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience". J Am Soc Echocardiogr. 2 (1): 17–24. doi:10.1016/s0894-7317(89)80025-2. PMID 2697302.
  3. ↑ Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P (July 1984). "Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography". Eur. Heart J. 5 (7): 545–55. doi:10.1093/oxfordjournals.eurheartj.a061704. PMID 6479181.
  4. ↑ Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H (March 1989). "Echocardiography in diagnosis of aortic dissection". Lancet. 1 (8636): 457–61. doi:10.1016/s0140-6736(89)91364-0. PMID 2563839.
  5. ↑ 5.0 5.1 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
  6. ↑ Evangelista, Arturo; Isselbacher, Eric M.; Bossone, Eduardo; Gleason, Thomas G.; Eusanio, Marco Di; Sechtem, Udo; Ehrlich, Marek P.; Trimarchi, Santi; Braverman, Alan C.; Myrmel, Truls; Harris, Kevin M.; Hutchinson, Stuart; O’Gara, Patrick; Suzuki, Toru; Nienaber, Christoph A.; Eagle, Kim A. (2018). "Insights From the International Registry of Acute Aortic Dissection". Circulation. 137 (17): 1846–1860. doi:10.1161/CIRCULATIONAHA.117.031264. ISSN 0009-7322.
  7. ↑ Writing Committee Members. Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW; et al. (2022). "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2022.08.004. PMID 36334952 Check |pmid= value (help).
  8. ↑ 8.0 8.1 8.2 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter |month= ignored (help)

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