Simultaneous examination of the aorta in echocardiography of patients with coronary artery disease

Abstract

The majority of aortic aneurysms are asymptomatic and are discovered incidentally on routine physical examination or on imaging studies for other indications [1], although the rupture of the aortic aneurysm can cause uncontrolled hemorrhage and rapid circulatory collapse. Atherosclerosis has been considered the underlying cause of aortic aneurysms, and the concomitant disorder of aortic aneurysm and coronary artery disease can be frequently observed [2]. Echocardiography is a basic modality to assess patients with coronary artery disease and can be used for the screening of aortic aneurysm. I would like to recommend the simultaneous examination of the aorta in the echocardiography of patients with coronary artery disease and propose the following screening method for aortic aneurysms. (1) Superior intercostal view (Fig. 1): left parasternal approach is a standard method for the long-axis view of the left ventricle, atrium, and proximal ascending aorta. The approach from the superior intercostal space can visualize the proximal to mid-portion of the ascending aorta. (2) Small-scale longaxis view (Fig. 2): the descending aorta can be seen behind the left atrium in the parasternal view of echocardiography by adjusting the window depth. (3) Subxiphoid view: abdominal aorta can be seen from subxiphoid and abdominal approaches. (4) Suprasternal view (Fig. 3): aortic arch to proximal descending aorta can be illuminated from the suprasternal approach on the ‘‘sniff’’ and supine position. These approaches may be recalled as the ‘‘four Ss’’. The routine evaluation of the aorta in echocardiography must make the time required for aortic echo shorter. Quick aortic echo using the four S approaches will be able to play an important role not only in the search for aortic aneurysm, but also in the evaluation of acute aortic dissection in the emergency room.