ECOCARDIOGRAFIA TRANSESOFAGICA

ENF DE LA AORTA

Dr Ricardo E Ronderos FACC FASE Jefe Dto de Imagenes cardiovasculares ICBA Director Instituto de Cardiologia La Plata Profesor libre de cardiologia de Postgrado Director Master Ultrasonido en Cardiologia Universidad Nacional de La Plata Argentina

ACUTE AORTIC SYNDROME

MARFAN SYNDROME AORTIC DISSECTION AORTIC MURAL HEMATOMA AORTIC ULCER AND PERFORATION AORTIC LUMINAL THROMBOSIS AORTIC ANEURYSM AND RUPTURE AORTIC TRAUMA AORTIC MYCOTIC ANEURYSM AND SEUDOANEURYSM

INCIDENCE AND PREVALENCE

1/ 10.000 ADMISSIONS IN GENERAL HOSPITALS 1/ 363 AUTOPSIES 10 CASES/ MILLON/ YEAR

AORTIC DISSECTION

OVER 2.000 CASES/ YEAR

AORTIC DISSECTION
MORTALITY
90 DAYS 30 DAYS 14 DAYS 7 DAYS 48 HS 24 HS 6 HS 15 MIN

% 0 20 40 60 80 100
Anagnostopoulos, Am.H.Journal 1972.

DEBAKEY AND STANFORD CLASSIFICATION

AORTIC DISSECTION

PREVALENCE ACCORDING TO DEBAKEY CLASSIFICATION

AORTIC DISSECTION

N = 128

48% TYPE I TYPE II TYPE III 35% 17% European Council Echocardiography 1993

AORTIC DISSECTION
INTIMAL TEARS

AORTIC DISSECTION COMPLICATIONS

ECO TRANSESOFAGICO
MULTIPLANO

DISECCION AORTICA

AORTIC DISSECTION
INTIMAL TEARS

AORTIC DISSECTION
PROXIMAL DISECTION

AORTIC DISSECTION

AORTIC DISSECTION
AORTIC ARCH

INTIMAL TEARS

DISECCION AORTICA
DESGARROS INTIMALES

DESCENDING AORTA

AORTIC DISSECTION
INTIMAL TEARS

Gated Sequential Acquisition

Off-line 3D Image Processing and Reconstruction

Aortic aneurysm 3DE reconstruction

Aortic aneurysm 3D reconstruction

Live 3D TEE

Live 3D TEE provides visualization of cardiac function never seen before

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SITIO DE ENTRADA

SITIO DE ENTRADA

Afectacin de ramas arteriales

Gentileza del Dr G Avegliano

EMERGENCIA DE LOS VASOS

Hemorragia Periartica

Gentileza del Dr G Avegliano

TRANSESOPHAGEAL ECHO
FALSE LUMEN SPONTANEOUS CONTRAST EFECT

TRANSESOPHAGEAL ECHO
TRUE LUMEN COAPTATION

DIAGNOSTIC TECHNIQUES
INTIMAL FLAP DIAGNOSIS INTIMAL TEARS ENTRY AND REENTRY DIAGNOSIS TRUE AND FALSE LUMEN FLOW PROFILES FALSE LUMEN THROMBOSIS AORTIC MAIN BRANCHES AORTIC REGURGITATION HAEMOPERICARDIUM CT NMR. ANGIO SCAN RX +++ +++ +++ 0 ++ 0 ++ + 0 +++ ++ +++ ++ +++ +++ ++ +++ +++ +++ ++ ++ +++ +++ 0 TEE +++ +++ +++ +++ +++ + +++ +++

AORTIC DISSECTION

AORTIC DISSECTION
DIAGNOSTIC TECHNIQUES

SENSITIVITY SPECIFICITY ADVANTAGES DISADVANTAGES ANGIO CT SCAN

80-90 % 65-85 % 90-95 % INVASIVE AORTIC NON DIAGNOSTIC BRANCHES MURAL HEMATOMA FAST NON DIAGNOSTIC WIDELY AORTIC AVAILABLE BRANCHES

MSLICE CT SCAN MRI TEE

80-100 % 95-100 %

95-100 % 95-100 %
AORTIC BRANCHES FLOW

PT TRANSFER LONG TIME STUDY SEMI-INVASIVE BAD AORTIC BRANCHES

95-100 %

85-95 %

FAST IN SITU REAL TIME FLOW

OBSTRUCTION CORONARY ARTERIES

AORTIC DISSECTION

ECO TRANSESOFAGICO
ARTERIAS CORONARIAS

AO

AO

TC MULTISLICE Y RMN
ARTERIAS CORONARIAS

RCA PL PDA
PL AV artery

PDA P

TC y RMN son superiores a ETE para evaluar dimensiones aorticas

EVALUACION DE PROTESIS

HEMATOMA INTRAMURAL

ANGIO

RM

ETE

AORTIC DISSECTION

INTRAMURAL HEMATOMA

TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA

TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA

TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA

TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA

EUROPEAN COUNCIL OF ECHOCARDIOGRAPHY

AORTIC DISSECTION

TYPE III Non communicant:

Mural haematoma distal to left subclavian artery, without comunicacin between true lumen and lesion

TYPE III Communicant:

Distal to left subclavian artery, with comunication between true and false lumen Antegrade dissection.

TYPE III Retrograde:

Distal to left subclavian artery, communication between true and false lumen with retrograde disection.

AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural haematoma

AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural haematoma

AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural haematoma

INTIMAL LESSIONS

AORTIC ULCERS

AORTIC PLAQUES
INTIMAL LESSIONS

Ulceras articas. Diagnstico etiolgico

AORTIC HAEMATOMA
INTIMAL LESSIONS

Ulcera penetrante artica

TRANSESOPHAGEAL ECHO
AORTIC PLAQUES AND TROMBUS

AORTIC TRAUMA
RUPTURE
RUPTURE

TRAUMA FIXED

FIXED

DIAGNOSTIC TECHNIQUES

AORTIC PATHOLOGY

AORTIC TRANSSECTION

TRANSESOPHAGEAL ECHO
AORTIC TRANSSECTION

TRANSESOPHAGEAL ECHO
AORTIC TRANSSECTION

PROXIMAL

DISTAL

TRANSESOPHAGEAL ECHO
AORTIC RUPTURE

AO

RUPTURE

AO

PSEUDOAN

TRANSESOPHAGEAL ECHO

AORTITIS AND SEUDOANEURISM

RUPTURE
AO

PSEUDOAN PSEUDOAN

TRANSESOPHAGEAL ECHO

AORTITIS AND SEUDOANEURYSM

ROLE OF TEE IN AORTIC PATHOLOGY

CONCLUSIONS
TEE IS ACCURATE, FAST AND GIVES ALMOST COMPLETE DIAGNOSIS IN ACUTE THORACIC AORTIC DISEASES
MULTIPLANE PROBES ARE NECESSARY TO REDUCE RISK OF AORTIC DISRUPTION MRI GIVES BETTER UNDERSTANDING OF ANATOMY AND MORPHOLOGY, BUT LESS INFORMATION ABOUT FLOW PROFILES IN RETROGRADE DISECTION

MULTIPLANE TEE IS ELECTIVE IN ACUTE SCENARIOS AND MRI IS EXCELLENT FOR CHRONIC FOLLOW UP

DIAGNOSTICO EN SOSPECHA DE SINDROME AORTICO AGUDO

Dolor toracico o dorsal
Baja probabilidad clinica
TAC helicoidal Con contraste

Alta probabilidad clinica

ETE
NORMAL
HEMATOMA DESCENDENTE
CONTROL ETE Y POST RMN

TIPO A CIRUGIA TIPO B

CONTROL ETE Y POST RMN

DISECCION

ETE
TIPO A CIRUGIA TIPO B
CONTROL ETE Y POST RMN