Retrograde Ascending Aortic Dissection Diagnosed by Intraoperative Transesophageal Echocardiography

Aortic dissection is a risky but challenging cardiovascular emergency and rapid surgical intervention for life-saving is sometimes inevitable. For detection of aortic dissection, computed tomography, magnetic resonance imaging, aortography all have their advantages but all have their limitations. Transesophageal echocardiography (TEE), which is portable and relatively noninvasive, is a highly sensitive and specific diagnostic tool for evaluation of aortic diseases. We presented a case in which preoperative imaging studies such as MRI and cardiac catheterization were all suggestive of DeBakey's type I aortic dissection. However, it was further proved to be a retrograde ascending aortic dissection during intraoperative TEE imaging study as a retrograde ascending blood flow was demonstrated within the dissected aortic lumen. So the initial operative scheme was changed and sternothoracoabdominal incision was selected for better exposure for one-stage repair of the entire thoracic aorta. Nevertheless, severe intrathoracic adhesion and ease to bleed prevented any aggressive intervention to proceed. The operation was called off and the patient was transferred to ICU for further medical treatment.

關鍵字

Aneurysm: dissecting ； Monitoring: echocardiography, transesophageal

並列摘要

動脈剝離是一種具有高罹病率及死亡率的心臟血管急症。由於解剖位置上食道貼近主動脈，因此，經食道心臟超音波檢查對整個胸主動脈及近端腹主動脈均有特殊之診斷價值。本篇是報告一位六十五歲女性，因右冠狀動脈阻塞，於十二年前曾經接受冠狀動脈繞道手術。本次手術前磁振造影及心導管檢查診斷為DeBakey氏分類第一型主動脈剝離，手術中經食道心臟超音波檢查分别於昇、降主動脈發現有血管內膜撕裂及浮動之皮瓣，彩色杜朴勒影像檢查進一步顯示為逆行性主動脈剝離。由於剝離的入口在降主動脈而出口在昇主動脈，與術前臆斷相反，因而影響手術的施行。此一病例發生的可能機轉及經食道心臟超音波檢查之重要性和對手術方式的影響，將一併在本文中討論。

並列關鍵字

動脈瘤：剝離；監測器：經食道心臟超音波

國際替代計量

Retrograde Ascending Aortic Dissection Diagnosed by Intraoperative Transesophageal Echocardiography

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