Transcript 4. Imaging Modalities 4.1. Recommendations for Aortic

Inter-hospital Conference 20 (2/2554)
Aortic surgery:
Update & Decision making
วันเสาร์ที่ 17 กันยายน 2554
ห้องประชุมสมาคมศิษย์เก่าแพทย์ศิริราช โรงพยาบาลศิริราช
1. Measurements of aortic diameter should be taken at
reproducible anatomic landmarks, perpendicular to
the axis of blood flow, and reported in a clear and
consistent format (see Table 5). (Level of Evidence: C)
2. For measurements taken by computed tomographic
imaging or magnetic resonance imaging, the external
diameter should be measured perpendicular to
the axis of blood flow. For aortic root measurements,
the widest diameter, typically at the mid-sinus level,
should be used. (Level of Evidence: C)
3. For measurements taken by echocardiography, the
internal diameter should be measured perpendicular
to the axis of blood flow. For aortic root measurements,
the widest diameter, typically at the midsinus
level, should be used. (Level of Evidence: C)
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Selection of the imaging study
patient-related factors
Institutional capabilities
Radiation exposure
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Other causes of patient’s symptom
sensitivity of a widened mediastinum or an
abnormal aortic contour associated with
significant thoracic aortic disease at 64% and
71%, respectively
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sensitivities and specificities are equivalent to CT a
multiplanar evaluation
identify anatomic variants of AoD (IMH and PAU)
branch artery involvement
aortic valve pathology and left ventricular
dysfunction
without exposing to radiation or iodinated contrast
prolonged duration
Gadolinium- renal insufficiency
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site of dissection, branch artery involvement,
and communication of the true and false
lumens
coronary artery and aortic branch (visceral and
limb artery) disease, as well as assessment of
aortic valve and left ventricular function
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1) not being universally available because it
requires the presence of an experienced
physician to perform the study
2) being an invasive procedure that is time
consuming and requires exposure to iodinated
contrast
3) having poor ability to diagnose IMH given a
lack of luminal disruption
4) potentially producing false negative results
when a thrombosed false lumen prevents
adequate
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suprasternal view
left (and sometimes right) parasternal
projection
TEE is superior to TTE for assessment of the
thoracic aorta
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aortic dilatation
suggests the underlying etiology of the aortic
disease (eg, bicuspid aortic valve)
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dissection flap
dissection flap has a motion independent of
surrounding structures
differential flow on the 2 sides of the dissection
flap
True lumen – systole, little or no SEC
False lumen – diastole, SEC, complete or partial
thrombosis
pericardial effusion
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right and left ventricular function
myocardial ischemia
2 coronary arteries
acute aortic regurgitation