Choice of investigation

In acute ascending aortic dissection, survival appears to be improved by rapid diagnosis followed as soon as possible by surgery (Cigarroa et al. 1991; Petasnick. 1991). In most hospitals diagnosis can be made most rapidly using non-invasive methods. CT scanning or transesophageal echocardiography are usually the most convenient. If available, transesophageal echocardiography is the method of choice. Aortography should be used if it is more readily available, more reliable locally, or if the results of non-invasive investigations are equivocal. There is an increasing body of opinion that once the diagnosis of ascending aortic dissection has been established by any means, attempting to refine the diagnosis by further investigation should be avoided. The priority should be to transfer the patient to the operating room as soon as possible where, if necessary, further evaluation can be performed using transesophageal echocardiography.

MRI is probably the investigation of choice in stable patients with chronic dissections or in patients presenting acutely with no evidence of ascending aortic involvement who require further evaluation of suspected type III dissection.

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