Circulation, Vol 80, 24-33, Copyright © 1989 by American Heart Association
S Mohr-Kahaly, R Erbel, H Rennollet, N Wittlich, M Drexler, H Oelert and J Meyer
Follow-up of 18 patients with aortic dissection (five with type I, one with
type II, 11 with type III dissection according to DeBakey) by
transesophageal, two-dimensional and color-coded Doppler echocardiography
showed a persistence of the false lumen in five of seven patients (71%)
after surgery and in nine of 11 patients (82%) after medical therapy. In
two patients treated with surgery, the dissected part of the aorta had been
resected, whereas in two patients treated medically, a progressive and
complete obliteration of the false lumen was observed. In the false lumen,
thrombus formation was absent in four, localized in four, and progressive
in six patients. Flow within the false lumen could be registered in 14
patients, and two distinct flow patterns were differentiated (laminar
biphasic flow or slowly circulating flow). Persisting intimal tears were
visualized by two-dimensional echocardiography in four patients, whereas
color-coded Doppler showed an additional one to three intimal tears in the
descending aorta in 10 patients. Flow across these intimal tears was
biphasic in 75% of patients; that is, systolic flow was directed from the
true to the false lumen with diastolic flow reversal. Unidirectional flow
was detected in 25% of the communications, directed in 20% from the true to
the false lumen, serving as an entry only and in one (5%) as reentry only.
Additional information concerning complications like extension of the
dissection (one of 18 patients), localized dilatation of the regurgitation
(three of 18 patients) were detected by this method. Concerning the
morphologic findings and the detection of flow characteristics, the
transesophageal approach was superior to conventional echocardiography
especially in the descending thoracic aorta. Thus, transesophageal
two-dimensional and color-coded Doppler echocardiography seems to be an
ideal method not only for the easy detection of aortic dissection but also
for follow-up.
ARTICLES
Ambulatory follow-up of aortic dissection by transesophageal two- dimensional and color-coded Doppler echocardiography
II. Medical Clinic, Johannes Gutenberg University Mainz, FRG.
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