Differential Transesophageal Echocardiographic Diagnosis Between Linear Artifacts and Intraluminal Flap of Aortic Dissection or Disruption: Results Protocol B
Among the 121 patients studied, 73 patients (60%) underwent the TEE study to rule out a spontaneous AD, while the remaining 48 victims of violent deceleration accidents (40%) were examined for suspected TDA. tadanafil
Of 33 patients with proven AD, 14 patients (42%) sustained a Stanford type-A AD while the remaining 19 patients (58%) had a type-B AD. Traumatic disruption of the aortic isthmus was confirmed in eight patients sustaining severe blunt chest trauma. Linear artifacts were observed in the ascending and descending segments of the thoracic aorta in 22 of 121 patients (18%) and 7 of 121 patients (6%), respectively. No acute associated aortic condition was found in 12 of 22 patients (54%) with a linear artifact in the ascending aorta, and in all patients with a reverberant image within the descending thoracic aorta. Of them, a single patient exhibited a linear artifact in both segments of the thoracic aorta. In 8 of 19 patients (42%) with proven Stanford type-B AD and in 2 of 8 patients (25%) with confirmed traumatic laceration of the aortic isthmus, a linear artifact in the ascending aorta was also observed. The frequency of linear artifacts and true flaps associated with either AD or TDA was similar between protocols (data not shown).
In two patients with true flap, all TEE diagnostic
criteria individually predictive of linear artifacts were observed. One patient sustained a type-A acute AD, without evidence for an entry tear. In this case, the diagnosis was based on the presence of an associated significant aortic regurgitation and pericardial effusion, and on TEE findings consistent with a dissection of the descending thoracic aorta with a thrombosed false lumen. The other patient had a traumatic disruption of the aortic isthmus. TEE clearly disclosed the presence of a false aneurysm formation with a medial flap. The systematic use of the abovedescribed TEE diagnostic criteria resulted in the absence of false-positive results. The combination of three of the four TEE criteria that were independent predictors of the presence of a linear artifact in the ascending aorta yielded the highest diagnostic specificity (Table 3). Similarly, the presence of a single TEE criterion identified using the logistic regression model provided the highest diagnostic accuracy (Table 3). When compared to protocol A, TEE specificity for the identification of true flaps in both segments of the thoracic aorta improved, and no patient underwent unnecessary surgery.