Jansen Klomp Wouter W, Peelen Linda M, Brandon Bravo Bruinsma George J, Van't Hof Arnoud W J, Grandjean Jan G, Nierich Arno P
Department of Cardiology, V2.2, ISALA, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Cardiovasc Ultrasound. 2016 Aug 3;14(1):28. doi: 10.1186/s12947-016-0071-6.
Transesophageal echocardiography (TEE) is a key diagnostic modality in patients with acute aortic dissection, yet its sensitivity is limited by a "blind-spot" caused by air in the trachea. After placement of a fluid-filled balloon in the trachea visualization of the thoracic aorta becomes possible. This method, modified TEE, has been shown to be an accurate test for the diagnosis of upper aortic atherosclerosis. In this study we discuss how we use modified TEE for the diagnosis and management of patients with (suspected) acute aortic dissection.
Modified TEE provides the possibility to obtain a complete echocardiographic overview of the thoracic aorta and its branching vessels with anatomical and functional information. It is a bedside test, and can thus be applied in hemodynamic instable patients who cannot undergo computed tomography. Visualization of the aortic arch allows differentiation between Stanford type A and B dissections and visualization of the proximal cerebral vessels enables a timely identification of impaired cerebral perfusion. During surgery modified TEE can be applied to identify the true lumen for cannulation, and to assure that the true lumen is perfused. Also, the innominate- and carotid arteries can be assessed for structural integrity and adequate perfusion during multiple phases of the surgical repair.
Modified TEE can reveal the "blind-spot" of conventional TEE. In patients with (suspected) aortic dissection it is thus possible to obtain a complete echocardiographic overview of the thoracic aorta and its branches. This is of specific merit in hemodynamically unstable patients who cannot undergo CT. Modified TEE can guide also guide the surgical management and monitor perfusion of the cerebral arteries.
经食管超声心动图（TEE）是急性主动脉夹层患者的关键诊断方式，但其敏感性受气管内气体导致的“盲点”限制。在气管内放置充满液体的球囊后，胸主动脉可视化成为可能。这种改良TEE方法已被证明是诊断升主动脉动脉粥样硬化的准确检查。在本研究中，我们讨论如何使用改良TEE诊断和管理（疑似）急性主动脉夹层患者。
改良TEE能够获取胸主动脉及其分支血管完整的超声心动图概况，并提供解剖和功能信息。它是一种床旁检查，因此可应用于无法进行计算机断层扫描的血流动力学不稳定患者。主动脉弓的可视化有助于区分斯坦福A型和B型夹层，近端脑血管的可视化能够及时识别脑灌注受损情况。手术期间，改良TEE可用于识别插管的真腔，并确保真腔得到灌注。此外，在手术修复的多个阶段，可以评估无名动脉和颈动脉的结构完整性及灌注是否充足。
改良TEE能够揭示传统TEE的“盲点”。对于（疑似）主动脉夹层患者，因此有可能获得胸主动脉及其分支完整的超声心动图概况。这对于无法进行CT检查的血流动力学不稳定患者具有特殊价值。改良TEE还可以指导手术管理并监测脑动脉灌注。
