The Dual Modality Use of Epiaortic Ultrasound and Transesophageal Echocardiography in the Diagnosis of Intraoperative Iatrogenic Type-A Aortic Dissection

Abstract

ATROGENIC INTRAOPERATIVE aortic dissection is a potentially fatal complication of cardiac surgery. Early diagnosis and treatment are vital to good outcome. Transesophageal echocardiography (TEE) is the modality of choice for diagnosis of aortic dissection, but the ability of TEE to detect localized aortic dissection at the distal ascending aorta and proximal aortic arch is compromised by shadowing from the air-filled interface of the trachea and bronchus. A case of acute intraoperative type-A aortic dissection after aortic cannulation that initially was not visualized by TEE but by epiaortic ultrasound is presented. This technique allowed early diagnosis of dissection surrounding the cannulation site, prompting successful replacement of the ascending aorta, with optimal clinical results.