Banning A P, Masani N D, Ikram S, Fraser A G, Hall R J
Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff.
Br Heart J. 1994 Nov;72(5):461-5. doi: 10.1136/hrt.72.5.461.
To assess the value and limitations of using transoesophageal echocardiography as the sole diagnostic test in patients with suspected thoracic aortic dissection.
Retrospective data review over a two year period.
A regional cardiothoracic centre.
Data were compiled from admission records, surgical records, and lists of patients undergoing diagnostic investigations in the hospital. Patient's notes were used to identify presentation, management, and outcome.
Patients were managed according to the policy of our unit, which is to treat patients with dissection affecting the ascending aorta by an operation. Patients with uncomplicated dissection sparing the ascending aorta are initially managed medically.
In hospital and two year follow-up of patients who were investigated by transoesophageal echocardiography alone.
Of 48 patients referred, 45 underwent transoesophageal echocardiography. Dissection was confirmed in 22 patients. Transoesophageal echocardiography showed the proximal extent of the dissection in 21/22 (96%) and only one patient required a further diagnostic investigation. Ten patients with dissection of the ascending aorta underwent graft replacement of the ascending aorta; operative mortality was 10% and their two year survival was 80%. Of the eight patients with dissection of the descending aorta, six were discharged home, and five were alive at two years. No patient without evidence of dissection on their initial transoesophageal echocardiographic examination required re-investigation into possible dissection in the two years after discharge.
In patients with suspected thoracic dissection transoesophageal echocardiography rapidly and safely gives all the necessary diagnostic information. Further investigations, including coronary angiography, before surgery are unnecessary.
评估经食管超声心动图作为疑似胸主动脉夹层患者唯一诊断检查方法的价值及局限性。
为期两年的回顾性数据审查。
一个地区性心胸中心。
数据来自入院记录、手术记录以及医院接受诊断性检查患者的名单。通过患者病历确定临床表现、治疗及转归。
患者按照本单位的政策进行治疗，即对升主动脉受累的夹层患者行手术治疗。未累及升主动脉的单纯性夹层患者初始采用药物治疗。
对仅接受经食管超声心动图检查患者的住院情况及两年随访结果。
在转诊的48例患者中，45例接受了经食管超声心动图检查。22例确诊为夹层。经食管超声心动图显示22例中的21例（96%）夹层的近端范围，仅1例患者需要进一步的诊断性检查。10例升主动脉夹层患者接受了升主动脉移植置换术；手术死亡率为10%，其两年生存率为80%。在8例降主动脉夹层患者中，6例出院回家，5例在两年时存活。初始经食管超声心动图检查无夹层证据的患者在出院后两年内均无需再次检查是否可能存在夹层。
对于疑似胸主动脉夹层的患者，经食管超声心动图能快速、安全地提供所有必要的诊断信息。术前无需进行包括冠状动脉造影在内的进一步检查。
