Aortic Root And Ascending Aorta

In a patient with suspected aortic dissection, the aortic root and ascending aorta should be imaged first because involvement of the ascending aorta makes the patient a potential surgical candidate.

Figure 4.10A. Schematic diagram demonstrating the relationship of esophagus to the aorta. Reprinted with permission from reference 29.

To visualize the aortic root the probe is advanced to approximately 30 cm from the incisors where the aortic valve can usually be identified (Figure 4.10B). The probe is then carefully withdrawn to the bifurcation of the pulmonary artery to visualize the proximal ascending aorta (Figure 4.10B). Optimal imaging of the ascending aorta can be obtained from the aortic valve to the pulmonary artery bifurcation. Careful incremental rotation of the imaging plane from 0 degree to 135 degrees is essential at each level to avoid missing a localized abnormality or erroneously interpreting an artifact as an intimal flap. The distal ascending aorta near the proximal arch cannot be adequately imaged because of the interposition of the left main stem bronchus between the ascending aorta and the esophagus. However, in the majority of cases, one may be able to image if not all then some portion of this aorta by careful probe

Figure 4.10B. This figure demonstrates the various tomographic sections of the aorta from the anulus to the level of diaphragm. Reprinted from J. Invasive Cardiol. 1 (1989), 328-338 with permission from HMP Communications.

manipulation in addition to incremental imaging from cross sectional to longitudinal views. Figures 4.11A, 4.11B, and 4.12 demonstrate type A aortic dissection. Classic intimal tear in the distal aortic arch of type B dissection is shown in Figure 4.13.

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