Aortic dissection

The diagnosis of aortic dissection can be established by transesophageal echocardiography, CT imaging, and MRI. While these diagnostic modalities are comparable in their accuracy of detecting aortic dissection, transesophageal echocardiography appears to be developing into the method of choice as it is available at the bedside and offers the capability for an immediate diagnosis in this life-threatening disorder with a very high early mortality ( CD Flgyre S).

CD Figure 5. Transesophageal echocardiography (short-axis view) of an intimal flap associated with aortic dissection of the ascending aorta.

Transesophageal echocardiography (short-axis view) of an intimal flap associated with aortic dissection of the ascending aorta. Intensive care patients

Echocardiography can quickly determine whether a cardiac disorder is the underlying cause of hemodynamic instability and thus guide further patient management. Transesophageal echocardiography is frequently used in patients on mechanical ventilation to monitor left ventricular function and its response to inotropic therapy, to assess the valvular function and characterize its cause and severity, and to identify pericardial effusions. Also, echocardiography provides an immediate assessment of the filling status of the left ventricle and permits diagnosis of a dynamic outflow tract obstruction that may be aggravated by volume depletion. Thus echocardiography offers important decision support regarding the requirement for and the appropriateness of inotropic therapy and volume substitution.

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