Diagnosis of aortic dissection: The value and limitations of transesophageal echocardiography

Aortic dissection requires prompt and reliable diagnosis. The purpose of this study was to assess the accuracy and limitations of transesophageal echocardiography (TEE) for the diagnosis of aortic dissection. Twenty seven patients with clinically suspected aortic dissection were investigated by means of TEE. TEE results were compared to intraoperative findings (n = 18), necropsy (n = 4), and magnetic resonance imaging (n = 5). The DeBakey classification was used for differentiation of dissection type. Twenty-three patients (85%) were correctly identified as having aortic dissection. Four false-positive TEE findings (15%) were confined to the nondissecting aneurysm of the ascending aorta in elderly patients. Retrospectively we found that protruding atherosclerotic plaques were recognized as small intimal flaps. Type of dissection was correctly diagnosed in all 23 patients, the primary entry site was identified in 15 patients (65%), aortic regurgitation was found in 55.5% of patients, and pericardial effusion was detected in 33.3%. We conclude that TEE allows accurate diagnosis and classification of aortic dissection. However, some cases could be overdiagnosed in lesions of the ascending aorta, especially in nondissecting aneurysms. Another limitation of TEE is the inability to define the primary entry site in some cases. Still, overall results may favor TEE as the primary bedside diagnostic procedure to identify patients requiring urgent surgical intervention.