Download PDF
Thorac Cardiovasc Surg 2001; 49(6): 343-348
DOI: 10.1055/s-2001-19057
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Value of Echocardiography in Patient Follow-Up after Surgically Corrected Type A Aortic Dissection[∗]

G. Dohmen1 , W. Kuroczynski1 , M. Dahm1 , S. Anaraki1 , C. Olker1 , S. Mohr-Kahaly2 , H. Oelert1
  • 1Department of Cardiothoracic and Vascular Surgery
  • 2Department of Cardiology
  • Johannes Gutenberg-University, Mainz, Germany
Further Information

Publication History

Publication Date:
17 December 2001 (online)

    Permissions and Reprints All articles of this category

Background: To identify patients (pts) at risk of late complications, follow-up after surgery for type A aortic dissection is essential. We assessed the value of echocardiography to monitor patients after surgery for type A aortic dissection. Methods: 80 out of 108 pts operated between 1989 and 1999 for type A aortic dissection survived surgery. 62 pts with at least one TEE, CT or MRI examinations during follow-up were included in this study. All pts had transthoracic echocardiography (TTE), 53 transesophageal echocardiography (TEE), 51 had CT, and 39 had MRI. Results: At the first follow-up, 12 of 48 pts with aortic valve sparing surgery presented with aortic insufficiency >I° detected using echocardiography. 16 pts evolved a distal aortic aneurysm of over 5 cm, all seen in TEE, CT and MRI. A distal intimal flap was present in 39 pts and could be seen in TEE, CT and MRI in all patients. A new proximal aortic root dissection took place in 5 pts. Progressive aortic pathology led to reoperation in 9 pts. TEE was especially useful in 2 pts to confirm redissection, in 1 pt to rule out redissection assumed by CT, and in 1 with paraprosthetic blood flow after ascending aortic replacement. MRI led to additional information in 1 patient with false aneurysm of the distal anastomosis and 1 with redissection not seen in TEE 6 month before. CT and MRI were superior to TEE in demonstrating aortic arch pathology, whereas TEE was more effective in showing the flow pattern and residual entry sites. Conclusions: Echocardiography is an effective and cost-saving diagnostic tool to monitor pts after surgery for type A aortic dissection, and should be the method of choice to ascertain aortic pathology initially after surgery. Follow-up intervals and need for additional CT or MRI should be determined afterwards according to specific pathologies.

Key words:

Type A aortic dissection - Echocardiography - Aortic cross-clamping time - Follow-up

1 Presented at the 30th annual meeting (Feb. 17-21, 2001) of The German Society of Thoracic and Cardiovascular Surgery in Leipzig, Germany.

References

  • 1 Moore N R, Parry A J, Trottmann-Dickenson B, Filial R, Westaby S. Fate of the native aorta after repair of acute type A dissection: a magnetic resonance imaging study.  Heart. 1996;  75 62-66
    PubMedGoogle Scholar
  • 2 Penco M, Paparoni S, Dagianti A. et al . Usefulness of transesophageal echocardiography in the assessment of aortic dissection.  Am J Cardiol. 2000;  86 (4a) 53 G-56 G
    PubMedGoogle Scholar
  • 3 Erbel R S, Mohr-Kahaly S, Rennollett H. et al . Diagnosis of aortic dissection: The value of transesophageal echocardiography.  Thorac Cardiovasc Surg. 1987;  2 126-133
    PubMedGoogle Scholar
  • 4 Heinemann M, Laas J, Karck M, Borst H G. Thoracic aortic aneurysms after acute type A aortic dissection: Necessity for follow-up.  Ann Thorac Surg. 1990;  49 580-584
    CrossrefPubMedGoogle Scholar
  • 5 Bachet J, Goudot B, Dreyfus G. et al . Surgery of acute type A dissection: What have we learned during the past 25 years?.  Z Kardiol. 2000;  89 (Suppl 7) 47-54
    PubMedGoogle Scholar
  • 6 Fukunaga S, Karck M, Harringer W, Cremer J, Rhein C, Haverich A. The use of gelatin-resorcin-formalin glue in acute type A aortic dissection.  Eur J Cardiothorac Surg. 1999;  15 564-569
    CrossrefPubMedGoogle Scholar
  • 7 Fattori R, Bacchi-Reggiani L, Bertaccini P. et al . Evolution of aortic dissection after surgical repair.  Am J Cardiol. 2000;  86 (8) 868-672
    CrossrefPubMedGoogle Scholar
  • 8 Erbel R, Oelert H, Meyer J. et al . Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography.  Circulation. 1993;  87 1604-1615
    PubMedGoogle Scholar
  • 9 Cecconi M, Lopez E, Zanoli R. et al . Postoperative follow-up of type A aortic dissection - experience with 67 patients.  G Ital Cardiol. 1999;  29 (8) 898-909
    PubMedGoogle Scholar
  • 10 Barron D J, Livesey S A, Brown I W, Delaney D J, Lamb R K. Monro JL. Twenty-year follow-up of acute type A dissection: The incidence and extent of distal aortic disease using magnetic resonance imaging.  J Card Surg. 1997;  12 147-159
    PubMedGoogle Scholar
  • 11 David T E, Feindel C M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta.  J Thorac Cardiovasc Surg. 1992;  103 617-622
    CrossrefPubMedGoogle Scholar
  • 12 Sarsam M AI, Yacoub M. Remodeling of the aortic valve annulus.  J Thorac Cardiovasc Surg. 1993;  105 435-438
    PubMedGoogle Scholar
  • 13 Graeter T P, Langer F, Nikoloudakis N, Aicher D, Schafers H J. Valve preserving operation in acute type A aortic dissection.  Ann Thorac Surg. 2000;  70 1460-1465
    CrossrefPubMedGoogle Scholar
  • 14 Masani N D, Banning A P, Jones R A, Ruttley M S, Fraser A G. Follow-up of chronic thoracic aortic dissection: Comparison of transesophageal echocardiography and magnetic resonance imaging.  Am Heart J. 1996;  131 1156-1163
    CrossrefPubMedGoogle Scholar
  • 15 Cesare E D, Giordano A V, Cerone G, De Remigis F, Deusanio G, Masciocchi C. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath hold MRA in the postoperative follow-up of dissecting aneurysms.  Int J Card Imaging. 2000;  16 (3) 135-147
    CrossrefPubMedGoogle Scholar
  • 16 Roudaut R P, Marcaggi X L, Deville C. et al . Value of transesophageal echocardiography combined with computed tomography for assessing repaired type A aortic dissection.  Am J Cardiol. 1992;  70 1468-1476
    CrossrefPubMedGoogle Scholar
  • 17 Simon P, Owen A, Moidl R. et al . Transoesophageal echocardiographic follow-up of patients with surgically treated aortic aneurysms.  Eur Heart J. 1995;  16 402-405
    PubMedGoogle Scholar
  • 18 Erbel R. Editorial comment: Ambulatory follow-up of aortic dissection: comparison between computed tomography and biplane transesophageal echocardiography.  Int J Card Imaging. 1996;  12 137-138
    CrossrefPubMedGoogle Scholar

1 Presented at the 30th annual meeting (Feb. 17-21, 2001) of The German Society of Thoracic and Cardiovascular Surgery in Leipzig, Germany.

Dr. Guido Dohmen

Klinik für Herz-, Thorax- und Gefäßchirurgie
Johannes-Gutenberg-Universität

Langenbeckstraße 1

55131 Mainz, Germany

Phone: +49 (6131) 17-0

Fax: +49 (6131) 17-6626

Email: dohmen@htg.klinik.uni-mainz.de

      >