Hoshina Rin, Kishima Hideyuki, Mine Takanao, Ishihara Masaharu
Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan.
Eur Heart J Case Rep. 2020 Nov 12;4(6):1-5. doi: 10.1093/ehjcr/ytaa333. eCollection 2020 Dec.
Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure.
A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery.
Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk-benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.
经食管超声心动图（TOE）是一种安全且有用的工具。在我们的病例中，我们呈现了一例在TOE检查过程中发生主动脉夹层的罕见病例。
一名79岁女性因反复阵发性心房颤动（AF）伴心悸被转诊至我院。术前心脏计算机断层扫描（CT）显示升主动脉轻度扩张（最大直径：40毫米）。我们决定对AF进行导管消融（CA），由于她的CHADS评分为4，因此在CA前推荐进行TOE检查。在CA前一天进行了TOE检查。TOE检查时她的体格检查无异常。探头插入后3分钟，升主动脉未发现异常。插入后5分钟，TOE显示升主动脉夹层且无心包积液。苏醒后，她出现严重背痛并接受了增强CT检查。计算机断层扫描显示斯坦福A型主动脉夹层从主动脉根部延伸至髂总动脉分叉处，右冠状动脉严重狭窄（最大直径；49毫米）。患者接受了升主动脉置换术以及右冠状动脉冠状动脉搭桥手术。
对于有主动脉夹层危险因素的患者，必须在充分镇静并持续监测血压的情况下进行经食管超声心动图检查。在做出决定前必须考虑TOE的风险效益。根据具体情况，可能需要用另一种检查方式替代TOE。
