iCi Frankfurt 2009, Session V, July 8th

How to Assess Aortic Dissection

and Aneurysms by ECHO

Th. Bartel, University Clinic Innsbruck

Aneurysms and dissection
due to wall degeneration
Hypertension (Overweight and cocaine
use increase risk)
Atherosclerotic changes and
calcification
Aortitis (Giant cell arteritis, Takayasu disease)
Connective tissue disorders (Marfans syn-
drome, Turners syndrome, Ehlers-Danlos syndrome)
Pregnancy (Especially during the third trimester)
Congenital (Coarctation, bicuspid aortic valve)
Traumatic (abrupt deceleration in an accident)
TTT initial diagnostic
modality
Ascending aorta
Parasternal long axis
Marfans syndrome
Annulus (1)
Bulb (2)
Sinutubular junction (3)
Ascending aorta (4)
Normal diameter ranges
1.4-2.1 cm/m2
TTT parasternal
long-axis view

Ascending aorta
Annulus dilatation
Aneurysm
Type A dissection
Aortic regurgitation
Pericardial effusion
TTT suprasternal
view

Aortic arch
Dimensions
Side branches
Dissection flap
Diastolic backflow
due to AR
Coarctation
Pressure gradient
TTT abdominal views

Abdominal aorta
Dimensions
Aneurysms
Dissection
TEE high sensitivity
but blind spots
TEE anterior views

Standard cut planes

3-chamber view
Great vessel view
short axis
Banana view
TEE anterior views

Type A Dissection
Dissection flap
True and false lumen
Perforation
Aortic regurgitation
Pericardial effusion
TEE posterior views
views
Type A and B dissection
TL and FL related to site
branches
Entry site
Entry flow
Pressure separation
between TL and FL
Aortic dissection
- classifications -
 Aortic dissection
- Svensson classification -

Classic IMH
dissection

Local AD PAU Traumatic/Iatrogenic

TEE Svensson class 3

Penetrating aortic ulcer

PAU identification
Perforation
Thrombus formation
TEE Svensson class 4

Intramural haematoma vs
simple plaques
IMH intimal
displacement
Plaque - surface
TEE interventional
treatment

Monitoring of aortic stenting

Stent placement
Stent apposition
Endoleak
Intravascular ultrasound

IVUS complements
cineangiography
Complications, e. g.
true lumen collapse
Periinterventional
monitoring
 Intraluminal phased array imaging

Stasis in FL after proximal stent implantation

Barte et al. AJC 2007
 Distal interventional fenestration of
the dissection flap

Guided by intraluminal phased-array imaging

Barte et al. Circulation 2003
 Distal interventional fenestration of
the dissection flap

Guided by intraluminal phased-array imaging

Barte et al. Circulation 2003
 Take home message

Echo meets essentials in aortic

disease: bed-site, fast, precise in
detailed and differential diagnostics
TTE first, but TEE is more sensitive
Echo monitoring and guidance
facilitate interventional treatment
Thank you for your
attention!

Please visit: www.thomas-bartel.com and

download original articles