Feasibility of Aortic Dissection Occlusion via Mini-thoracotomy by Trans-esophageal Echocardiography Guidance / 中国循环杂志

ABSTRACT

Objectives: To explore the feasibility of aortic dissection (AD) occlusion via mini-thoracotomy by trans-esophageal echocardiography (TEE) guidance. Methods: Pre-operative TEE was conducted in 2 AD patients, the findings were compared with trans-thoracic echocardiography (TTE) to confirm the diagnosis with quantitative evaluation in order to accurately guiding the wire and sheath pipe into the rupture crevasse of AD for assessing the position, stability and the effect of closure device on local blood flow. Results: TEE confirmed that 2 patients could be treated by interventional plugging and the crevasses of AD were successfully blocked by TEE guidance. Case 1 had DeBakey II AD, crevasse shunt disappeared upon blocking, false lumen formed thrombosis, the diameter reduced form 40 mm to 28 mm and the cavity was retracted about 40%. Case 2 had the ulcer type AD located in aortic arch, closure device was closely suit to aortic wall, spread well and crevasse shunt disappeared;blood flow in aortic arch was about 110 cm/s which was similar at pre- and post-operation, no vascular stenosis and local dilatation were found, vital sign was stable. Follow-up TTE was performed at 1 month after the operation which showed the position of closure devices were normal in both patients. Conclusions: TEE could effectively confirm pre-operative AD diagnosis and provide intuitive image and quantitative information for accurately guiding closure position and evaluating surgical result. Mini-thoracotomy with TEE guidance is feasible for interventional therapy of AD.