PubMed · 518192
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F Gosalbez, J L Cofiño, J L Naya, F A de Linera. 1979. Retrograde aortic dissection.. https://doi.org/10.1016/s0003-4975(10)63187-6
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The introduction of transesophageal echocardiography (TEE) as a 'semi-invasive' technique with few complications in clinical practice represents a major diagnostic advance in the evaluation of cardiac disease. The close anatomic vicinity of the transducer to the heart and thoracic aorta allows the use of high frequency devices with better resolution compared to transthoracic echocardiography. Furthermore, the diagnostic gain when evaluating structures that are poorly visualized by the transthoracic approach such as the left atrial appendage, interatrial septum, prosthetic valves and the thoracic aorta is highly improved by TEE. Major indications for TEE include the search for a cardiac source of embolism and cardiac tumors, the work-up prior to balloon mitral valvuloplasty, the evaluation of prosthetic valves and the search for vegetations and aortic dissection. After a short summary of patient preparation, instrumentation and examination technique, the major indications, contraindications and complications are reviewed on the basis of our own experience and the literature.
A typical case history of spontaneous dissection of the internal carotid artery is presented. In young patients with cerebral ischemia, initial pain in the affected side of the head and neck, a possible provocative mechanism and a transient or even persistent Horner's syndrome are highly suggestive. The angiographic picture of carotid artery dissection is characteristic. Spontaneous resolution is common, and recurrence rare. Surgical treatment can therefore be reserved for individual cases with recurrent ischemia and caused by emboli originating in the dissected segment of the artery.