Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge •...
Transcript of Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge •...
![Page 1: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/1.jpg)
Diseases Of The Aorta
A/Prof David Prior
St Vincent’s Hospital
Melbourne Sports Cardiology
![Page 2: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/2.jpg)
What Happens To Aortas
• Grow • Pop • Tear • Block • Embolize
![Page 3: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/3.jpg)
Outline
• Anatomy & nomenclature • Aortic measurements • Aortic aneurysm • Acute aortic syndromes
– aortic dissection and variants
• Aortic coarctation • Atherosclerosis
![Page 4: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/4.jpg)
Outline
• Anatomy & nomenclature • Aortic measurements • Aortic aneurysm • Acute aortic syndromes
– aortic dissection and variants
• Aortic coarctation • Atherosclerosis
![Page 5: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/5.jpg)
Anatomy
Erbel, EHJ 2014 35:2873
Size varies with: - Age - Gender - Body size (height, weight
and BSA)
![Page 6: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/6.jpg)
Age, Gender and BSA
Goldstein JASE 2015 28:119
![Page 7: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/7.jpg)
Clinical Case
![Page 8: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/8.jpg)
Importance Of Serial Measures
2006
5.4 cm 5.2 cm
2016
![Page 9: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/9.jpg)
Guidance On Imaging the Aorta
Goldstein JASE 2015 28:119
![Page 10: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/10.jpg)
Measuring The Aorta
• End-diastole • Leading edge to leading
edge • Perpendicular to the
long axis • Compare to previous
images • Measurements may be
different to other modalities
Goldstein JASE 2015 28:119
![Page 11: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/11.jpg)
Normal Range
Goldstein JASE 2015 28:119
![Page 12: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/12.jpg)
![Page 13: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/13.jpg)
Thoracic Aortic Aneurysm
• Familial / Genetic – Marfan syndrome – Bicuspid aortic valve-related aortopathy – Ehlers-Danlos syndrome (Type IV) – Loeys-Dietz syndrome – Thoracic aortic aneurysm syndrome
• Acquired – Hypertension – Infective (Syphilis, salmonella) – Atherosclerosis – Trauma
Will need echo for surveillance
May need echo for diagnosis
![Page 14: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/14.jpg)
Thoracic Aortic Aneurysm
• Familial / Genetic – Marfan syndrome – Bicuspid aortic valve-related aortopathy – Ehlers-Danlos syndrome (Type IV) – Loeys-Dietz syndrome – Thoracic aortic aneurysm syndrome
• Acquired – Hypertension – Infective (Syphilis, salmonella) – Atherosclerosis – Trauma
Most common conditions requiring screening of patients & relatives
![Page 15: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/15.jpg)
Choice Of Imaging Modality
Goldstein JASE 2015 28:119
![Page 16: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/16.jpg)
Aortic Dissection - Classification
Erbel, EHJ 2014 35:2873
SURGERY
STENT or
MEDICAL
![Page 17: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/17.jpg)
Aortic Dissection
![Page 18: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/18.jpg)
Chest Pain
• 82 Y.O. male • Sudden onset chest pain in chest and scapula • Presented to ED • Minor T wave changes on ECG
• Echocardiogram requested - ?AMI
![Page 19: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/19.jpg)
![Page 20: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/20.jpg)
![Page 21: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/21.jpg)
![Page 22: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/22.jpg)
![Page 23: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/23.jpg)
![Page 24: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/24.jpg)
![Page 25: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/25.jpg)
![Page 26: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/26.jpg)
![Page 27: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/27.jpg)
Progress
• Urgent CT scan – “complex dissection involving the aortic arch,
ascending and descending aorta arising from the aortic root…..”
• Urgent surgery – AVR and repair of dissection
![Page 28: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/28.jpg)
![Page 29: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/29.jpg)
Role Of Echo in Dissection TTE & TEE
• Identification of a dissection flap • Determine the extent of dissection & ?location
of entry point • Complications
– Aortic valve function – Pericardial effusion & tamponade – LV function and regional wall motion (dissection of
coronary ostia)
![Page 30: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/30.jpg)
Artifacts in Aortic Imaging
Bertrand JASE 2016 29:381
![Page 31: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/31.jpg)
Dissection of Balloon
Appelbe JACC 1993 21:754
![Page 32: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/32.jpg)
60 YO female with resistant hypertension
Ascending 5.2 cm
Arch
![Page 33: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/33.jpg)
![Page 34: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/34.jpg)
Admitted to Hospital for Ix of HPT & Aorta • Pain during procedure with marked hypertension • Subsequent chest pain and hypotension
![Page 35: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/35.jpg)
Asc Ao Arch
![Page 36: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/36.jpg)
Descending Thoracic Aorta
• Type A dissection
• True vs False Lumen
• Surgery
![Page 37: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/37.jpg)
Chest Pain 3 Weeks Post CABG
![Page 38: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/38.jpg)
Urgent TEE
![Page 39: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/39.jpg)
Descending Aorta
![Page 40: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/40.jpg)
CT scanning for dissection
![Page 41: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/41.jpg)
MRI for Aortic Dissection
![Page 42: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/42.jpg)
Test Accuracy
Goldstein JASE 2015 28:119 Moore AmJCard 2002 89:1235
![Page 43: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/43.jpg)
Choice of Imaging Modality for Aortic Dissection
Goldstein JASE 2015 28:119
![Page 44: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/44.jpg)
Intramural Haematoma
• A localized contained dissection
![Page 45: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/45.jpg)
Admitted to Hospital for Ix of HPT & Aorta
![Page 46: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/46.jpg)
Aortic Coarctation
![Page 47: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/47.jpg)
Aortic Atheroma
• May be a source of systemic embolism
![Page 48: Diseases Of The Aorta · Measuring The Aorta • End-diastole • Leading edge to leading edge • Perpendicular to the long axis • Compare to previous images • Measurements may](https://reader034.fdocuments.in/reader034/viewer/2022042316/5f05927f7e708231d413a07a/html5/thumbnails/48.jpg)
Summary
• Both TTE and TEE have a role in the investigation & management of aortic disease
• Often used in conjunction with other imaging modalities
• Consistent and accurate measurement is critical for serial studies
• Echo provides additional information about valve & ventricular funciton in aortic dissection