aortic surgery Interhospital Conference 20 22554 Aortic surgery Update amp Decision making วน เสารท 17 กนยายน 2554 ID: 211138
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Slide1
Preoperative evaluation for aortic surgery
Inter-hospital Conference 20
(2/2554)
Aortic surgery:
Update & Decision making
วัน
เสาร์ที่ 17 กันยายน
2554
ห้อง
ประชุมสมาคมศิษย์เก่าแพทย์ศิริราช โรงพยาบาลศิริราช
Slide2
4. Imaging Modalities4.1. Recommendations for Aortic Imaging
Techniques
1. Measurements of aortic diameter should be taken at
reproducible anatomic landmarks
, perpendicular to
the axis of blood flow
, and reported in a clear and
consistent format (see Table 5). (
Level of Evidence: C)
2. For measurements taken by
computed
tomographic
imaging or magnetic resonance imaging
, the external
diameter
should be measured perpendicular to
the axis of blood flow. For aortic root measurements,
the widest diameter, typically at the mid-sinus level,
should be used. (
Level of Evidence: C)
3. For measurements taken by
echocardiography
, the
internal diameter
should be measured perpendicular
to the axis of blood flow. For aortic root measurements,
the widest diameter, typically at the
midsinus
level, should be used. (
Level of Evidence: C)Slide3
Selection of the imaging study
patient-related factors
Institutional capabilitiesRadiation exposureSlide4
CXROther causes of patient’s symptom
sensitivity of a widened
mediastinum or an abnormal aortic contour associated with significant thoracic aortic disease at
64% and 71%
, respectivelySlide5
CXRSlide6
CT scanSlide7Slide8Slide9Slide10
MRIsensitivities and specificities are equivalent to CT a
multiplanar
evaluationidentify anatomic variants of AoD
(IMH and PAU)
branch artery involvement
aortic valve pathology and left ventricular dysfunction
without exposing to radiation or iodinated contrast
prolonged duration
Gadolinium- renal insufficiencySlide11
Angiographysite of dissection, branch artery involvement, and communication of the true and false lumenscoronary artery and aortic branch (visceral and limb artery) disease, as well as assessment of aortic valve and left ventricular functionSlide12
Disadvantages
1) not being universally available because it requires the presence of an experienced physician to perform the study
2) being an invasive procedure that is time consuming and requires exposure to iodinated contrast3) having poor ability to diagnose IMH given a lack of luminal disruption
4) potentially producing false negative results when a
thrombosed
false lumen prevents adequateSlide13
Echocardiographysuprasternal view
left (and sometimes right)
parasternal projectionTEE is superior to TTE for assessment of the thoracic aortaSlide14
Echocardiographic Criteria for ThoracicAortic Aneurysms
aortic dilatation
suggests the underlying etiology of the aortic disease (eg
, bicuspid aortic valve)Slide15Slide16
Echocardiographic Criteria for Aortic Dissection
dissection flap
dissection flap has a motion independent of surrounding structuresdifferential flow on the 2 sides of the dissection flapTrue lumen – systole, little or no SEC
False lumen – diastole, SEC, complete or partial thrombosis
pericardial effusionSlide17
right and left ventricular function myocardial ischemia2 coronary arteries
acute aortic regurgitationSlide18Slide19