title: Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of aortic aneurysm and dissection.
abstract: We compared findings from intraoperative live/real time three-dimensional transesophageal echocardiography (3DTEE) and two-dimensional transesophageal echocardiography (2DTEE) with surgery in 67 patients having aortic aneurysm and/or aortic dissection. Of these, 20 patients had aortic aneurysm without dissection, 21 aortic aneurysm and dissection, and 26 aortic dissection without aneurysm. 3DTEE diagnosed the type and location of aneurysm correctly in all patients unlike 2DTEE, which missed an aneurysm in one case. There were four cases of aortic aneurysm rupture. Three of them were diagnosed by 3DTEE but only one by 2DTEE, and one missed by both techniques. The mouth of saccular aneurysm, site of aortic aneurysm rupture, and communication sites between perfusing and nonperfusing lumens of aortic dissection could be viewed en face only with 3DTEE, enabling comprehensive measurements of their area and dimensions as well as increasing the confidence level of their diagnosis. In all patients with aortic dissection, 3DTEE enabled a more confident diagnosis of dissection because the dissection flap when viewed en face presented as a sheet of tissue rather than a linear echo seen on 2DTEE which can be confused with an artifact. 2DTEE missed dissection in one patient. In six cases the dissection flap involved the right coronary artery orifice by 3DTEE and surgery. These were missed by 2DTEE. Aortic regurgitation severity was more comprehensively assessed by 3DTEE than 2DTEE. Aneurysm size by 3DTEE correlated well with 2DTEE and surgery/computed tomography scan. In conclusion, 3DTEE provides incremental information over 2DTEE in patients with aortic aneurysm and dissection.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.forename: Elif Ijlal
authors.initials: EI
authors.lastname: Bicer
authors.forename: Cevdet
authors.initials: C
authors.lastname: Donmez
authors.forename: Ming C
authors.initials: MC
authors.lastname: Hsiung
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.forename: Kamel
authors.initials: K
authors.lastname: Sadat
authors.forename: Selvin
authors.initials: S
authors.lastname: Sudhakar
authors.forename: Hisham
authors.initials: H
authors.lastname: Ibrahim
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Pandey
authors.forename: Nidhi
authors.initials: N
authors.lastname: Karia
authors.forename: Kunal
authors.initials: K
authors.lastname: Bhagatwala
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.lastname: Jeng-Wei
authors.lastname: Chung-Yi-Chang
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chung
authors.forename: Shen-Kou
authors.initials: SK
authors.lastname: Tsai
authors.forename: Bhavin
authors.initials: B
authors.lastname: Dumaswala
authors.forename: Komal
authors.initials: K
authors.lastname: Dumaswala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging*; D003199:Computer Systems; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult