753-2 Biplane and Multiplane Transesophageal Echocardiography in Suspected Acute Aortic Dissection

Between 1991–1994, 130 pts, (95 men, age 17–88 yrs.) were evaluated by bi or multiplane transesophageal echocardiography (TEE) because of suspected acute aortic dissection (AD) (112 pts) or acute extension of chronic dissection (CD) (18 pts). TEE results were compared to diagnoses obtained by surgery/necropsy (55%) or by at least one additional imaging method.Results—The accuracy of TEE in AD: AD was present in 49 (type A in 30, Type B in 19) of the 112 pts. (44%) and 8 of them had intramural hematoma (IMH). TEE found AD in 48/49 pts. with, and excluded AD in 78/81 without, that diagnosis. The 1 pt. with false negative TEE had a 1.5cm thrombosed false lumen in the ascending aorta (Asc Ao). Two pts. with Type A AD (1 with IMH and 1 with thrombosed false lumen in the Asc Ao) were classified as type BAD. The 3 false positive diagnoses were in 2 pts. with large aneurysms of the Asc Ao and in 1 in the Desc Ao. The accuracy of TEE for AD was:ADType A ADType B ADIMHSensitivity (%)989010089Specificity (%)96979998Microscopic evaluation of surgical specimens in 6 with IMH of Asc Ao showed similar findings to classical AD. Complications of AD, CD and enlarging aneurysms were evaluated in the 130 pts. TEE showed 100% accuracy for aortic regurgitation and pericardial ruptures. The sensitivities were 75%, 85% and 11%, respectively for TEE for pseudoaneurysms (12 pts), hemothorax (20 pts) and hemomediastinum (9 pts), with the specificity for all 100%.ConclusionsBi and multiplane TEE accurately detected AD and its major complications, but thrombosed false lumen, intramural hematomas and pseudoaneurysms need special attention. TEE was inaccurate in identifying mediastinal leaks and ruptures