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The current role of echocardiography in acute aortic syndrome

Echo Research & Practice volume 6, pages R53–R63 (2019)Cite this article

Abstract

Acute aortic syndrome (AAS) comprises a range of interrelated conditions caused by disruption of the medial layer of the aortic wall, including aortic dissection, intramural haematoma and penetrating aortic ulcer. Since mortality from AAS is high, a prompt and accurate diagnosis using imaging techniques is paramount. Both transthoracic (TTE) and transoesophageal echocardiography (TEE) are useful in the diagnosis of AAS. TTE should be the first imaging technique to evaluate patients with thoracic pain in the emergency room. Should AAS be suspected, contrast administration is recommended when images are not definitive. TEE allows high-quality images in thoracic aorta. The main drawback of this technique is that it is semi-invasive and the presence of a blind area that limits visualisation of the distal ascending aorta near. TEE identifies the location and size of the entry tear, secondary communications, true lumen compression and the dynamic flow pattern of false lumen. Although computed tomography (CT) is the most used imaging technique in the diagnosis of AAS, echocardiography offers complementary information relevant for its management. The best imaging strategy for appropriately diagnosing and assessing AAS is to combine CT, mainly ECG-gated contrast-enhanced CT, and TTE. Currently, TEE tends to be carried out in the operating theatre immediately before surgical or endovascular therapy and in monitoring their results. The aims of this review are to establish the current role of echocardiography in the diagnosis and management of AAS based on its advantages and limitations.

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This review did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Cardiovascular Imaging Department, University Hospital Vall d’Hebron, CIBER-CV, Barcelona, Spain

    Arturo Evangelista MD PhD FESC, Domenico Gruosso MD, Laura Gutiérrez MD, Chiara Granato MD, Nicolas Villalva MD, Laura Galian MD, Teresa González-Alujas MD PhD, Gisela Teixido MD PhD & Jose Rodríguez-Palomares MD PhD

  2. Cardiovascular Imaging Department, Instituto del Corazon, Quironsalud Teknon, Barcelona, Spain

    Giuliana Maldonado MD

Authors
  1. Arturo Evangelista MD PhD FESC
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  2. Giuliana Maldonado MD
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  3. Domenico Gruosso MD
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Correspondence to Arturo Evangelista MD PhD FESC.

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Evangelista, A., Maldonado, G., Gruosso, D. et al. The current role of echocardiography in acute aortic syndrome. Echo Res Pract 6, R53–R63 (2019). https://doi.org/10.1530/ERP-18-0058

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Key Words

  • acute aortic syndrome
  • aortic dissection
  • transoesophageal echocardiography
  • transthoracic echocardiography
  • echocardiography in aortic surgery

Echo Research & Practice

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