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Ann Thorac Surg 2003;76:948
© 2003 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

True lumen collapse assessed by epiaortic echocardiography in aortic dissection

Angel L. Fernández, MD, PhDa*, Amparo Martínez, MD, PhDb, Julian Alvarez, MD, PhDc, José Rubio, MD, PhDb, José B. García-Bengochea, MD, PhDb

a Departments of Cardiac Surgery, Santiago de Compostela, Spain
b Cardiology, Santiago de Compostela, Spain
c Anesthesiology, University Hospital, Santiago de Compostela, Spain

* Address reprint requests to Dr Fernández, Department of Cardiac Surgery, University Hospital, Ave Choupana, S/N, 15706 Santiago de Compostela, Spain
e-mail: alfg{at}inicia.es

A 47-year-old man with a history of hypertension was admitted to the emergency room because of prolonged acute retrosternal pain radiating to the back and a transient episode of left hemiparesis. A thoracic computed tomographic scan demonstrated an aortic dissection of the ascending aorta and aortic arch. A transthoracic echocardiogram showed a normal systolic function with a hypertrophic left ventricle and a significant pericardial effusion. Intravenous infusion of labetalol hydrochloride was started and the patient was referred to our unit for an emergency operation. Before arriving at the operating room, a new episode of transient left hemiparesis was observed. After median sternotomy and pericardiotomy, the ascending aorta was scanned using a 7-MHz vascular ultrasound transducer. The probe was inserted into a sterile plastic sleeve with a small volume of saline added. The pericardial craddle was filled with saline to surround the aorta and allow better image quality. The probe was placed directly on the anterior surface of the ascending aorta at the level of the right pulmonary artery (RPA). A dissection of the ascending aorta with a changing configuration of the dissection flap during the cardiac cycle was demonstrated (Fig 1). A transverse view showed a true lumen (TL) diastolic collapse. TL diameter was maximun during systole and it was reduced progressively during diastole. Sequence 1 was obtained during systole. Sequences 2 through 6 were obtained from protodiastole to the end of diastole. After hypothermic circulatory arrest, the aorta was opened and a false lumen (FL) surrounding a smaller TL could be observed. Surgical correction was performed in the usual fashion. The patient fully recovered neurologic function after operation. Epiaortic ultrasound scanning has emerged as a useful technique to assess atheromatosis of the ascending aorta. Intraoperative epiaortic scanning in acute aortic dissection may constitute a new and valuable application. This case illustrates the diastolic collapse of the TL, a known mechanism of aortic branch vessel compromise and ischemia in patients with acute aortic dissection.



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Home page
 Interact CardioVasc Thorac SurgHome page
S. Demertzis, G. Casso, T. Torre, and F. Siclari
Direct epiaortic ultrasound scanning for the rapid confirmation of intraoperative aortic dissection
Interact CardioVasc Thorac Surg, August 1, 2008; 7(4): 725 - 726.
[Abstract] [Full Text] [PDF]

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