Wang Cindy J, Rodriguez Diaz Cesar A, Trinh Muoi A
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA.
Ann Card Anaesth. 2015 Jan-Mar;18(1):83-6. doi: 10.4103/0971-9784.148326.
Stanford type A aortic dissections often present to the hospital requiring emergent surgical intervention. Initial diagnosis is usually made by computed tomography; however transesophageal echocardiography (TEE) can further characterize aortic dissections with specific advantages: It may be performed on an unstable patient, it can be used intra-operatively, and it has the ability to provide continuous real-time information. Three-dimensional (3D) TEE has become more accessible over recent years allowing it to serve as an additional tool in the operating room. We present a case series of three patients presenting with type A aortic dissections and the advantages of intra-operative 3D TEE to diagnose the extent of dissection in each case. Prior case reports have demonstrated the use of 3D TEE in type A aortic dissections to characterize the extent of dissection and involvement of neighboring structures. In our three cases described, 3D TEE provided additional understanding of spatial relationships between the dissection flap and neighboring structures such as the aortic valve and coronary orifices that were not fully appreciated with two-dimensional TEE, which affected surgical decisions in the operating room. This case series demonstrates the utility and benefit of real-time 3D TEE during intra-operative management of a type A aortic dissection.
斯坦福A型主动脉夹层通常在医院就诊时需要紧急手术干预。初始诊断通常通过计算机断层扫描进行；然而，经食管超声心动图（TEE）具有特定优势，可进一步明确主动脉夹层：它可在不稳定患者身上进行，可在术中使用，并且能够提供连续的实时信息。近年来，三维（3D）TEE的应用更加普及，使其能够作为手术室中的一种辅助工具。我们展示了一组三例A型主动脉夹层患者的病例系列，以及术中3D TEE在诊断每例夹层范围方面的优势。先前的病例报告已证明3D TEE在A型主动脉夹层中的应用，以明确夹层范围及相邻结构的受累情况。在我们描述的三例病例中，3D TEE提供了对夹层瓣与相邻结构（如主动脉瓣和冠状动脉开口）之间空间关系的进一步理解，而二维TEE对此并未完全明确，这影响了手术室中的手术决策。该病例系列证明了实时3D TEE在A型主动脉夹层术中管理中的实用性和益处。
