EVALUATION OF CARDIOVASCULAR PATHOLOGIES (see also Chapter 50 )

Aortic Diseases

TEE has a proven role in the assessment of aortic injury and aortic dissection when prompt and accurate diagnosis is vital to patient survival. In one study of 160 consecutive victims of blunt chest trauma, TEE was diagnostically superior to and faster than aortography for detection of aortic injury.^[79] Unlike aortography, TEE reliably distinguishes between subadventitial disruptions that require emergency surgery and intimal tears that do not.^{[80] [81]} For the detection of aortic dissection, TEE has proved superior to aortography and computed tomography.^[82] It is associated with a shorter time to diagnosis, less morbidity (renal dysfunction and neurologic events), and shorter hospital stays than aortography is.^[83] Though marginally less sensitive and specific than magnetic resonance imaging (MRI) for some dissections (those originating in the aortic arch, where TEE imaging is partially obstructed by the trachea), TEE requires less time and expense than MRI or any other comparably reliable alternative does.^[84] Moreover, TEE can delineate the mechanisms and severity of associated aortic regurgitation, thereby identifying patients in whom valve repair is likely to be successful.^[85] Thus, TEE is the test of choice in unstable patients with suspected aortic injury or aortic dissection because a delay in surgery could prove fatal to these patients.