Diseases of the aorta

Abstract

Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the standard echocardiographic examination. Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, particularly the aortic root and proximal ascending aorta. Transoesophageal echocardiography (TOE) overcomes the limitations of TTE in thoracic aorta assessment. TTE and TOE should be used in a complementary manner. Echocardiography is useful for assessing aorta size, biophysical properties, and atherosclerotic involvement of the thoracic aorta. TTE appears to suffice for aortic root assessment. TOE is the gold standard in thoracic aorta assessment. It provides excellent morphological information on aortic dissection and is superior to TTE in the diagnosis of intramural haematomas and aortic ulcers. TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TOE should define entry tear location, mechanisms and severity of aortic regurgitation, and true lumen compression. In addition, echocardiography is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications. Although other imaging techniques have a greater field of view and may yield complementary information, echocardiography is portable, rapid, accurate and cost-effective in the diagnosis and follow-up of most aortic diseases.