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__NOTOC__
{{Template:Aortic dissection}}
{{Template:Aortic dissection}}
 
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} {{Sahar}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==Overview==
==Overview==
The [[echocardiographic]] changes [[diagnostic]] of aortic dissection include [[Intimal]] flaps in the [[aorta]] obstruction of a false lumen, [[intimal]] [[calcification]] displacement toward the center of the lumen, separation of [[intimal]] layers from the [[thrombus]], and shearing of different wall layers during aortic pulsation. The [[sensitivity]] and [[specificity]] of [[transthoracic echocardiography]] vary based on the type of [[dissection]] and are usually lower for the [[diagnosis]] of distally located aortic dissection. [[Echocardiography]] may also show severe [[pleural effusion]], which is suggestive of the development of [[cardiac tamponade]]. [[Transesophageal echocardiography (TEE)|Transesophageal echocardiography]] may be useful in the [[diagnosis]] of aortic dissection in [[patients]] in whom [[transthoracic echocardiography]] has limited efficacy. Prolapse of [[intimal]] flap through the [[aortic valve]] seen in [[transesophageal echocardiography]] is [[diagnostic]] of aortic dissection complicated by [[aortic regurgitation]]. [[Sensitivity]] is usually higher (99%). However, it has limited usage in the [[diagnosis]] of [[dissections]] involving the distal portion of [[ascending aorta]].
== Echocardiography ==
== Echocardiography ==
===Transthoracic Echocardiography===
The [[echocardiographic]] changes [[diagnostic]] of aortic dissection include:<ref name="pmid463760">{{cite journal |vauthors=Mintz GS, Kotler MN, Segal BL, Parry WR |title=Two dimensional echocardiographic recognition of the descending thoracic aorta |journal=Am. J. Cardiol. |volume=44 |issue=2 |pages=232–8 |date=August 1979 |pmid=463760 |doi=10.1016/0002-9149(79)90310-2 |url=}}</ref><ref name="pmid2697302">{{cite journal |vauthors=Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller FA, Stanson AW, Sinak LJ, Oh JK, Seward JB |title=Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience |journal=J Am Soc Echocardiogr |volume=2 |issue=1 |pages=17–24 |date=1989 |pmid=2697302 |doi=10.1016/s0894-7317(89)80025-2 |url=}}</ref><ref name="pmid6479181">{{cite journal |vauthors=Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P |title=Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography |journal=Eur. Heart J. |volume=5 |issue=7 |pages=545–55 |date=July 1984 |pmid=6479181 |doi=10.1093/oxfordjournals.eurheartj.a061704 |url=}}</ref><ref name="pmid2563839">{{cite journal |vauthors=Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H |title=Echocardiography in diagnosis of aortic dissection |journal=Lancet |volume=1 |issue=8636 |pages=457–61 |date=March 1989 |pmid=2563839 |doi=10.1016/s0140-6736(89)91364-0 |url=}}</ref>
*[[Intimal]] flaps in the [[aorta]]
* Obstruction of a false lumen
*[[Intimal]] [[calcification]] displacement toward the center of the lumen
* Separation of [[intimal]] layers from the thrombus
* Shearing of different wall layers during aortic pulsation


The [[transesophageal echocardiogram]] (TEE) is a relatively good test in the diagnosis of aortic dissection, with a sensitivity of up to 98% and a specificity of up to 97%. It is a relatively [[non-invasive (medical)|non-invasive test]], requiring the individual to swallow the echocardiography probe. It is especially good in the evaluation of AI in the setting of ascending aortic dissection, and to determine whether the ostia (origins) of the coronary arteries are involved. While many institutions give sedation during transesophageal echocardiography for added patient-comfort, it can be performed in cooperative individuals without the use of sedation. Disadvantages of the TEE include the inability to visualize the distal ascending aorta (the beginning of the [[aortic arch]]), and the descending abdominal aorta that lies bellow the [[stomach]]. A TEE may be technically difficult to perform in individuals with esophageal strictures or [[varices]].
The [[sensitivity]] and [[specificity]] of [[transthoracic echocardiography]] vary based on the type of dissection and are usually lower for the [[diagnosis]] of distally located aortic dissection.<br>
 
[[Echocardiography]] may also show severe [[pleural effusion]], which is suggestive of the development of [[cardiac tamponade]].
Transthoracic (TTE) unfortunately does not provide pretty pictures of the distal ascending, transverse and descending aorta in a small number of patients. Its use is limited to assess cardiac complications of dissection including AI, tamponade and LV function.
===Transesophageal Echocardiography===
 
[[Transesophageal echocardiography]] may be useful in the [[diagnosis]] of aortic dissection in [[patients]] in whom [[transthoracic echocardiography]] has limited efficacy.<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>
Transesophageal (TEE), however, is a portable technique that can be brought to the emergency department and establish a diagnosis in < 5 minutes of starting the test. It can identify true and false lumens, the intimal flap, thrombosis in the false lumen, pericardial effusion, AI, and the proximal coronaries. Although monoplane TEE has a sensitivity of 98%, its specificity is only 77%. This can be increased to a sensitivity and specificity of 99% and 98% respectively with combined use of TTE and TEE. Biplane and multiplane imagine however have been shown to be 98% sensitive and 95% specific for aortic dissection.
*Prolapse of [[intimal]] flap through the [[aortic valve]] seen in [[transesophageal echocardiography]] is [[diagnostic]] of aortic dissection complicated by [[aortic regurgitation]].<ref name="EvangelistaIsselbacher2018">{{cite journal|last1=Evangelista|first1=Arturo|last2=Isselbacher|first2=Eric M.|last3=Bossone|first3=Eduardo|last4=Gleason|first4=Thomas G.|last5=Eusanio|first5=Marco Di|last6=Sechtem|first6=Udo|last7=Ehrlich|first7=Marek P.|last8=Trimarchi|first8=Santi|last9=Braverman|first9=Alan C.|last10=Myrmel|first10=Truls|last11=Harris|first11=Kevin M.|last12=Hutchinson|first12=Stuart|last13=O’Gara|first13=Patrick|last14=Suzuki|first14=Toru|last15=Nienaber|first15=Christoph A.|last16=Eagle|first16=Kim A.|title=Insights From the International Registry of Acute Aortic Dissection|journal=Circulation|volume=137|issue=17|year=2018|pages=1846–1860|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031264}}</ref>
 
*[[Sensitivity]] is usually higher (99%). However, it has limited usage in the [[diagnosis]] of [[dissections]] involving the distal portion of [[ascending aorta]].
In general, it is recommended to perform bedside multiplane TEE in patients with acute symptoms or clinically unstable, and MRI in patients with a more chronic presentation if they are hemodynamically stable.
==Echocardiography Examples of Aortic dissection==
 
{|align="center"
CT angio is reserved for patients whom TEE or MRI is unavailable or contraindicated. Aortography is required if the tests listed above are non-diagnostic.
|-
 
|[[Image:Aortic dissection - Echocardiogram - Longitudinal view.jpg|420px|thumb|left|[[Echocardiogram]] of an [[aortic]] dissection]] || [[Image:Aortic dissection - Echocardiogram - Longitudinal view - Color.jpg|420px|thumb|left|[[Echocardiogram]] of an [[aortic]] dissection]]
|}
===Aortic Dissection===
{|align="center"
{|align="center"
|-
|-
|[[Image:Aortic dissection - Echocardiogram - Longitudinal view.jpg|420px|thumb|left|Echocardiogram of an aortic dissection]] || [[Image:Aortic dissection - Echocardiogram - Longitudinal view - Color.jpg|420px|thumb|left|Echocardiogram of an aortic dissection]]
|{{#ev:youtube|nD8DrZCPFBI}}
|}
|}
{{#ev:youtube|nD8DrZCPFBI}}


===Aortic Dissection Type A===
===Aortic Dissection Type A===
 
{|
{| align="center
|- valign="top" | Aortic Dissection Type A
|- valign="top" | Aortic Dissection Type A
! width="80" | Example 1
! width="80" | Example 1
! width="250" | {{#ev:googlevideo|1580944144837691434}}
! width="250" | {{#ev:googlevideo|-1580944144837691434}}
! width="80" | Example 2  
! width="80" | Example 2  
! width="250" | {{#ev:googlevideo|3610218405615821421}}
! width="250" | {{#ev:googlevideo|-3610218405615821421}}
|-valign="top"  
|-valign="top"  
! width="80" | Example 3
! width="80" | Example 3
! width="250" | {{#ev:googlevideo|8461290621229660122}}
! width="250" | {{#ev:googlevideo|-8461290621229660122}}
! width="80" | Example 4
! width="80" | Example 4
! width="250" | {{#ev:googlevideo|8561147882050584609}}
! width="250" | {{#ev:googlevideo|-8561147882050584609}}
|-valign="top"  
|-valign="top"  
! width="80" | Example 5
! width="80" | Example 5
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! width="80" | Example 6
! width="80" | Example 6
! width="250" |{{#ev:googlevideo|698950344523479477}}
! width="250" |{{#ev:googlevideo|698950344523479477}}
|}
===Aortic Dissection Type B===
{|
|-valign="top" | Aortic dissection Type B
! width="80" | Example 1
! width="250" | {{#ev:googlevideo|3238725821918795498}}
! width="80" | Example 2
! width="250" | {{#ev:googlevideo|197658671308723787}}
|}
|}


Aortic Dissection Type A Example 1
== 2022 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease <ref name="pmid36334952">{{cite journal| author=Writing Committee Members. Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW | display-authors=etal| title=2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume=  | issue=  | pages=  | pmid=36334952 | doi=10.1016/j.jacc.2022.08.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36334952  }}</ref> ==


<googlevideo>-1580944144837691434&hl=en </googlevideo>
=== screening tests ===
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |'''1.'''In patients with TAD who have a pathogenic/likely pathogenic variant, genetic testing of at-risk biological relatives (ie, cascade testing) is recommended. In family members who are found by genetic screening to have inherited the pathogenic/likely pathogenic variant, aortic imaging with TTE (if aortic root and ascending aorta are adequately visualized, otherwise with CT or MRI) is recommended.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
|}
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |In patients with a suspected AAS, TEE and MRI are reasonable alternatives for initial diagnostic imaging''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''
|}


{{-}}
==2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>==
===Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''Initial recommended [[imaging]] study for the [[diagnosis]] of [[acute aortic syndrome]] is [[transthoracic echocardiography]]. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon" |<nowiki>"</nowiki>''In stable [[patients]], [[transoesophageal echocardiography]] is the recommended [[imaging]] study. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


Aortic Dissection Type A Example 2


<googlevideo>-3610218405615821421&hl=en</googlevideo>
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>==
===Screening Tests (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Urgent and definitive imaging of the [[aorta]] using [[transesophageal echocardiogram]], [[computed tomographic imaging]], or [[magnetic resonance imaging]] is recommended to identify or exclude [[thoracic aorta|thoracic]] [[aortic]] dissection in patients at high risk for the disease by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


{{-}}
===Determining the Presence and Progression of Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>===
 
{|class="wikitable"
Aortic Dissection Type A Example 3
|-
 
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
<googlevideo>-8461290621229660122&hl=en</googlevideo>
|-
 
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Measurements of [[aortic]] diameter should be taken at reproducible [[anatomy|anatomic]] landmarks, perpendicular to the axis of blood flow, and reported in a clear and consistent format. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
{{-}}
|-
 
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For measurements taken by [[echocardiography]], the internal diameter should be measured perpendicular to the axis of blood flow. For [[aortic root]] measurements, the widest diameter, typically at the mid sinus level, should be used. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
Aortic Dissection Type A Example 4
|-
 
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Abnormalities of [[aortic]] morphology should be recognized and reported separately even when [[aortic]] diameters are within normal limits. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
<googlevideo>-8561147882050584609&hl=en</googlevideo>
|}
 
{{-}}
Aortic Dissection Type A Example 5
 
<googlevideo>2157100999251300976&hl=en</googlevideo>
 
{{-}}
Aortic Dissection Type A Example 6
 
<googlevideo>698950344523479477&hl=en</googlevideo>
 
{{-}}
 
Aortic Dissection Type B Example 1
 
<googlevideo>3238725821918795498&hl=en</googlevideo>
 
{{-}}
 
Aortic Dissection Type B Example 2
 
<googlevideo>197658671308723787&hl=en</googlevideo>
 
{{-}}


== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
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Latest revision as of 03:48, 3 December 2022

Aortic dissection Microchapters

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Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

The echocardiographic changes diagnostic of aortic dissection include Intimal flaps in the aorta obstruction of a false lumen, intimal calcification displacement toward the center of the lumen, separation of intimal layers from the thrombus, and shearing of different wall layers during aortic pulsation. The sensitivity and specificity of transthoracic echocardiography vary based on the type of dissection and are usually lower for the diagnosis of distally located aortic dissection. Echocardiography may also show severe pleural effusion, which is suggestive of the development of cardiac tamponade. Transesophageal echocardiography may be useful in the diagnosis of aortic dissection in patients in whom transthoracic echocardiography has limited efficacy. Prolapse of intimal flap through the aortic valve seen in transesophageal echocardiography is diagnostic of aortic dissection complicated by aortic regurgitation. Sensitivity is usually higher (99%). However, it has limited usage in the diagnosis of dissections involving the distal portion of ascending aorta.

Echocardiography

Transthoracic Echocardiography

The echocardiographic changes diagnostic of aortic dissection include:[1][2][3][4]

  • Intimal flaps in the aorta
  • Obstruction of a false lumen
  • Intimal calcification displacement toward the center of the lumen
  • Separation of intimal layers from the thrombus
  • Shearing of different wall layers during aortic pulsation

The sensitivity and specificity of transthoracic echocardiography vary based on the type of dissection and are usually lower for the diagnosis of distally located aortic dissection.
Echocardiography may also show severe pleural effusion, which is suggestive of the development of cardiac tamponade.

Transesophageal Echocardiography

Transesophageal echocardiography may be useful in the diagnosis of aortic dissection in patients in whom transthoracic echocardiography has limited efficacy.[5]

Echocardiography Examples of Aortic dissection

Echocardiogram of an aortic dissection
Echocardiogram of an aortic dissection

Aortic Dissection

nD8DrZCPFBI}}

Aortic Dissection Type A

Example 1 {{#ev:googlevideo|-1580944144837691434}} Example 2 {{#ev:googlevideo|-3610218405615821421}}
Example 3 {{#ev:googlevideo|-8461290621229660122}} Example 4 {{#ev:googlevideo|-8561147882050584609}}
Example 5 {{#ev:googlevideo|2157100999251300976}} Example 6 {{#ev:googlevideo|698950344523479477}}

Aortic Dissection Type B

Example 1 {{#ev:googlevideo|3238725821918795498}} Example 2 {{#ev:googlevideo|197658671308723787}}

2022 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease [7]

screening tests

Class I
1.In patients with TAD who have a pathogenic/likely pathogenic variant, genetic testing of at-risk biological relatives (ie, cascade testing) is recommended. In family members who are found by genetic screening to have inherited the pathogenic/likely pathogenic variant, aortic imaging with TTE (if aortic root and ascending aorta are adequately visualized, otherwise with CT or MRI) is recommended.(Level of Evidence: B-NR)
Class IIa
In patients with a suspected AAS, TEE and MRI are reasonable alternatives for initial diagnostic imaging(Level of Evidence: C-LD)

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[5]

Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection

Class I
"Initial recommended imaging study for the diagnosis of acute aortic syndrome is transthoracic echocardiography. (Level of Evidence: C)"
Class IIa
"In stable patients, transoesophageal echocardiography is the recommended imaging study. (Level of Evidence: C)"


2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[8]

Screening Tests (DO NOT EDIT)[8]

Class I
"1. Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening. (Level of Evidence: B)"

Determining the Presence and Progression of Thoracic Aortic Disease (DO NOT EDIT)[8]

Class I
"1. Measurements of aortic diameter should be taken at reproducible anatomic landmarks, perpendicular to the axis of blood flow, and reported in a clear and consistent format. (Level of Evidence: C)"
"2. For measurements taken by echocardiography, the internal diameter should be measured perpendicular to the axis of blood flow. For aortic root measurements, the widest diameter, typically at the mid sinus level, should be used. (Level of Evidence: C)"
"3. Abnormalities of aortic morphology should be recognized and reported separately even when aortic diameters are within normal limits. (Level of Evidence: C)"

References

  1. ↑ Mintz GS, Kotler MN, Segal BL, Parry WR (August 1979). "Two dimensional echocardiographic recognition of the descending thoracic aorta". Am. J. Cardiol. 44 (2): 232–8. doi:10.1016/0002-9149(79)90310-2. PMID 463760.
  2. ↑ Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller FA, Stanson AW, Sinak LJ, Oh JK, Seward JB (1989). "Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience". J Am Soc Echocardiogr. 2 (1): 17–24. doi:10.1016/s0894-7317(89)80025-2. PMID 2697302.
  3. ↑ Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P (July 1984). "Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography". Eur. Heart J. 5 (7): 545–55. doi:10.1093/oxfordjournals.eurheartj.a061704. PMID 6479181.
  4. ↑ Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H (March 1989). "Echocardiography in diagnosis of aortic dissection". Lancet. 1 (8636): 457–61. doi:10.1016/s0140-6736(89)91364-0. PMID 2563839.
  5. ↑ 5.0 5.1 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
  6. ↑ Evangelista, Arturo; Isselbacher, Eric M.; Bossone, Eduardo; Gleason, Thomas G.; Eusanio, Marco Di; Sechtem, Udo; Ehrlich, Marek P.; Trimarchi, Santi; Braverman, Alan C.; Myrmel, Truls; Harris, Kevin M.; Hutchinson, Stuart; O’Gara, Patrick; Suzuki, Toru; Nienaber, Christoph A.; Eagle, Kim A. (2018). "Insights From the International Registry of Acute Aortic Dissection". Circulation. 137 (17): 1846–1860. doi:10.1161/CIRCULATIONAHA.117.031264. ISSN 0009-7322.
  7. ↑ Writing Committee Members. Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW; et al. (2022). "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2022.08.004. PMID 36334952 Check |pmid= value (help).
  8. ↑ 8.0 8.1 8.2 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter |month= ignored (help)

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