Keren A, Kim C B, Hu B S, Eyngorina I, Billingham M E, Mitchell R S, Miller D C, Popp R L, Schnittger I
Division of Cardiovascular Medicine, Stanford University Medical Center, California, USA.
J Am Coll Cardiol. 1996 Sep;28(3):627-36. doi: 10.1016/0735-1097(96)00186-6.
The purpose of this study was to evaluate the diagnostic accuracy of biplane and multiplane transesophageal echocardiography in patients with suspected aortic dissection, including intramural hematoma.
Transesophageal echocardiography is a useful technique for rapid bedside evaluation of patients with suspected acute aortic dissection. The sensitivity of transesophageal echocardiography is high, but the diagnostic accuracy of biplane and multiplane transesophageal echocardiography for dissection and intramural hematoma is less well defined.
We studied 112 consecutive patients at a major referral center who had undergone biplane or multiplane transesophageal echocardiography to identify aortic dissection. The presence, absence and type of aortic dissection (type A or B, typical dissection or intramural hematoma) were confirmed by operation or autopsy in 60 patients and by other imaging techniques in all. The accuracy of transesophageal echocardiography for ancillary findings of aortic dissection (intimal flap, fenestration and thrombosis) was assessed in the 60 patients with available surgical data.
Of the 112 patients, aortic dissection was present in 49 (44%); 10 of these had intramural hematoma (5 with and 5 without involvement of the ascending aorta). Of the remaining 63 patients without dissection, 33 (29%) had aortic aneurysm and 30 (27%) had neither dissection nor aneurysm. The overall sensitivity and specificity of transesophageal echocardiography for the presence of dissection were 98% and 95%, respectively. The specificity for type A and type B dissection was 97% and 99%, respectively. The sensitivity and specificity for intramural hematoma was 90% and 99%, respectively. The accuracy of transesophageal echocardiography for diagnosis of acute significant aortic regurgitation and pericardial tamponade was 100%.
Biplane and multiplane transesophageal echocardiography are highly accurate for prospective identification of the presence and site of aortic dissection, its ancillary findings and major complications in a large series of patients with varied aortic pathology. Intramural hematoma carries a high complication rate and should be treated identically with aortic dissection.
本研究旨在评估双平面和多平面经食管超声心动图对疑似主动脉夹层（包括壁内血肿）患者的诊断准确性。
经食管超声心动图是对疑似急性主动脉夹层患者进行快速床旁评估的有用技术。经食管超声心动图的敏感性较高，但双平面和多平面经食管超声心动图对夹层和壁内血肿的诊断准确性尚不太明确。
我们在一家主要转诊中心对112例连续患者进行了研究，这些患者均接受了双平面或多平面经食管超声心动图检查以确定主动脉夹层。60例患者通过手术或尸检确诊了主动脉夹层的存在、不存在及类型（A型或B型、典型夹层或壁内血肿），所有患者均通过其他成像技术确诊。在60例有可用手术数据的患者中评估了经食管超声心动图对主动脉夹层辅助表现（内膜瓣、破口和血栓形成）的准确性。
112例患者中，49例（44%）存在主动脉夹层；其中10例有壁内血肿（5例累及升主动脉，5例未累及升主动脉）。其余63例无夹层的患者中，33例（29%）有主动脉瘤，30例（27%）既无夹层也无动脉瘤。经食管超声心动图对夹层存在的总体敏感性和特异性分别为98%和95%。对A型和B型夹层的特异性分别为97%和99%。对壁内血肿的敏感性和特异性分别为90%和99%。经食管超声心动图对急性重度主动脉反流和心包填塞的诊断准确性为100%。
双平面和多平面经食管超声心动图在大量具有不同主动脉病变的患者中对前瞻性识别主动脉夹层的存在和部位、其辅助表现及主要并发症具有高度准确性。壁内血肿的并发症发生率很高，应与主动脉夹层同样治疗。
