title: The role of contrast enhanced transesophageal echocardiography in the diagnosis and in the morphological and functional characterization of acute aortic syndromes.
abstract: The aim of this study is to evaluate the role of contrast transesophageal echocardiography (cTEE) in the diagnostic characterization of acute aortic syndromes (AAS) [aortic dissection, intramural hematoma, penetrating ulcer]. We enrolled 66 non-consecutive patients with clinical suspicion of AAS. Standard transesophageal echocardiography and cTEE were performed prior to gated-CT angiography, which has been assumed as reference standard. cTEE was obtained with a single bolus of contrast agent injection. The definitive diagnosis of AAS was made in 48 patients by gated-CT angiography: 22 aortic dissections, 15 intramural hematomas and 11 penetrating aortic ulcers. Standard TEE and cTEE correctly diagnosed AAS in 87 and 100% (P = 0.03) cases respectively. Standard TEE correctly diagnosed aortic dissection in 20/22 (91%) and cTEE in 22/22 (100 %) (P = 0.5) cases. cTEE was superior than standard TEE in the visualization of false lumen entry tear (22/22 vs. 16/22, P = 0.03). Standard TEE correctly diagnosed intramural hematoma in 11/15 and cTEE 15/15 (P = 0.12) cases. Microtears were identified in 3 patients by cTEE an in 1 patient by standard TEE (P = 0.4). The presence of focal contrast enhancement was identified in 4 and 0 patients by cTEE and standard TEE respectively (P = 0.06). Both standard and cTEE correctly diagnosed penetrating aortic ulcer in 11/11 (100%) (P = 1.0) cases. cTEE provides additional value over standard TEE in the diagnosis and in the anatomic and functional characterization of AAS.
authors.affiliation: Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Massimo
authors.initials: M
authors.lastname: Slavich
authors.forename: Luca
authors.initials: L
authors.lastname: Bertoglio
authors.forename: Andrea
authors.initials: A
authors.lastname: Fisicaro
authors.forename: Michele
authors.initials: M
authors.lastname: Oppizzi
authors.forename: Enrico
authors.initials: E
authors.lastname: Marone
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tufaro
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods; D003287:Contrast Media; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010743:Phospholipids; D011237:Predictive Value of Tests; D013459:Sulfur Hexafluoride; D013577:Syndrome; D014456:Ulcer / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
references.citation: Br Heart J. 1994 Nov;72(5):461-5
references.pmid: 7818964
references.citation: Rev Esp Cardiol. 2007 Apr;60(4):428-39
references.pmid: 17521551
references.citation: Am J Cardiol. 2001 Feb 1;87(3):315-9
references.pmid: 11165967
references.citation: Circulation. 2005 Dec 13;112(24):3802-13
references.pmid: 16344407
references.citation: Circulation. 1993 May;87(5):1604-15
references.pmid: 8491016
references.citation: Eur J Echocardiogr. 2009 Jan;10(1):i31-9
references.pmid: 19131497
references.citation: Heart. 2001 Apr;85(4):365-8
references.pmid: 11250953
references.citation: Cleve Clin J Med. 2008 Jan;75(1):7-9, 12, 15-7 passim
references.pmid: 18236724
references.citation: Am Heart J. 1997 Sep;134(3):495-507
references.pmid: 9327708
references.citation: Circulation. 1991 Nov;84(5):1903-14
references.pmid: 1934367
references.citation: Ann Vasc Surg. 1986 May;1(1):15-23
references.pmid: 3504683
references.citation: Circulation. 1989 Jul;80(1):24-33
references.pmid: 2736753
references.citation: Circulation. 2010 Sep 14;122(11 Suppl):S74-80
references.pmid: 20837929
references.citation: Arch Intern Med. 2006 Jul 10;166(13):1350-6
references.pmid: 16831999
references.citation: Radiology. 2011 Apr;259(1):100-8
references.pmid: 21330562
references.citation: Herz. 2011 Sep;36(6):488-97
references.pmid: 21887530
references.citation: Circulation. 1991 Nov;84(5 Suppl):III7-13
references.pmid: 1934444
references.citation: J Am Coll Cardiol. 2010 Apr 6;55(14):e27-e129
references.pmid: 20359588
references.citation: J Card Surg. 2002 Mar-Apr;17(2):95-106
references.pmid: 12220074
references.citation: Circulation. 1999 Mar 16;99(10):1331-6
references.pmid: 10077517
references.citation: Am J Cardiol. 2002 Mar 1;89(5):548-51
references.pmid: 11867039
references.citation: Circulation. 2002 Jul 16;106(3):284-5
references.pmid: 12119238
references.citation: Circulation. 1995 Sep 15;92(6):1465-72
references.pmid: 7664428
references.citation: Int J Cardiovasc Imaging. 2007 Dec;23(6):747-56
references.pmid: 17285264
references.citation: Radiology. 2001 Mar;218(3):719-23
references.pmid: 11230645
references.citation: J Am Coll Cardiol. 1994 Mar 1;23(3):658-64
references.pmid: 8113549
references.citation: Eur Heart J. 2010 Feb;31(4):472-9
references.pmid: 20037148
references.citation: N Engl J Med. 1993 Jan 7;328(1):1-9
references.pmid: 8416265