The descending thoracic aorta is easily imaged from the level of the arch to the diaphragm (Figures 4.10A, 4.10B). The probe is initially advanced into the stomach at about 50 cm and then progressively withdrawn in approximately 2-cm increments. In patients with an ectatic, tortuous, or aneurysmal aorta, the image planes may be oblique, and therefore use of a multiplane TEE probe is essential for through examination. TEE appearance of a type III dissection is shown in (Figures 4.7 and 4.13).
The morphology of the individual segments of the aorta should be assessed carefully for an increase in aortic wall thickness, to identify the intimal flap and entry site. Similarly, identifying the morphological features of true and false lumen, extent of thrombus and flow dynamics at each level is essential.
Once the aorta has been fully examined, attention should be diverted to the cardiac structures to assess the morphology of the aortic valve, presence of aortic regurgitation, left ventricular function, presence of wall motion abnormalities, other valvular pathology, and the presence and size of pericardial and pleural effusions. It is important to know that one should spend time gathering these data only in cases where TTE was not performed.
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