Middle East Heart Congress

Transesophageal Echocardiography (TEE) has become a widely used imaging technique for evaluating the thoracic aorta and there is solid evidence that the technique contributes valuable information about aortic structure and pathology. The evidence strongly supports the use of TEE in aortic aneurysm, dissection, atherosclerosis, ulceration, trauma and congenital or inherited malformation. Aortic aneurysms can be classifi ed according to their location in the ascending aorta, aortic arch, descending thoracic aorta or any combination thereof. Any patient with a thoracic aortic aneurysm larger than 5 cm in diameter should be considered for operative repair due to the considerable risks for rupture. Furthermore any patient with an aneurysmal segment of the aorta that attains a luminal diameter more than two times that of a normal aortic segment, which can usually be estimated in an unaff ected area at the level of the aortic arch or the abdominal aorta vessels, should be considered for surgery. Patients with connective tissue disease, such as Marfan syndrome or Ehlers-Danlos syndrome, may be considered for surgery at an earlier time. Th e Crawford classifi cation delineates four types of thoraco-abdominal aneurysms. Th oracic aortic dissections are classifi ed by either of two schemes. Th e Stanford classifi cation separates aortic dissections into type A, in which the dissection involves the ascending aorta and type B, in which the dissection is confi ned to the descending thoracic aorta. Th e DeBakey system classifi es dissections as type I, in which the dissection starts in the ascending aorta and involves variable portions of the descending aorta; type II, in which the dissection is confi ned to the ascending aorta and type III, in which the dissection originates distal to the left sub-clavian artery and either involves only the descending thoracic aorta (III-A) or extends into the abdominal segment of the descending aorta (III-B). Intramural hematomas of the thoracic aorta are classifi ed the same way as thoracic aortic dissections. Penetrating ulcer disease of the thoracic aorta is still a relatively poorly defi ned condition that is generally classifi ed in relation to the anatomic location of the lesion. Th e clinicians should have a high level of suspicion towards any pitfalls and artifacts as in few diseases are an accurate and timely diagnosis more important than in those of the thoracic aorta.