**5. Diagnosis**


**Figure 2.** *Chest X-ray of a patient with ATAD showing a widened mediastinum.*


The following information may be provided from a CT-scan:


Limitations of CT-scanning include not providing information about dissection entry site and functional status of the heart.

**65**

**Figure 4.**

*TEE of a patient with ATAD.*

*Current and Future Management Strategies of Type A Aortic Dissection*

5.Trans-oesophageal echocardiography (TEE; **Figure 4**)

a.The dissection flap and false lumen in ascending aorta

TEE is portable, less invasive and has sensitivity and specificity approximately

g.Has a better window than TTE to visualise aortic arch and descending aorta

Limitations include difficulty in visualisation of the proximal arch due to the

MRI is an accurate investigative modality for acute aortic dissection (sensitivity and specificity, 98%) [18]. It is rarely used in the setting of TAAD where most of the patients are wheeled into operating room as soon as the diagnosis is made. It may have a small role in those patients allergic to iodinated contrast agents or in patients

Its role is controversial [19]. Justification of not performing cardiac catheterisation include risk of catheter induced aortic rupture and delaying surgery where percentage

*DOI: http://dx.doi.org/10.5772/intechopen.93015*

100% [16]. It provides information about:

b.The entry site of tear using colour Doppler

d.Dilation of aorta and left ventricle function

e.Pericardial effusion and tamponade

h.Pleural effusion

interposition of bronchial air [17].

6.**Magnetic resonance imaging (MRI)**

7.**Preoperative coronary angiography:**

mortality increases by 1 % every hour [20].

with acute renal failure who are stable enough to undergo MRI.

c.Coronary ostial obstruction due to the dissection

f. Aortic regurgitation and anatomy of aortic root

**Figure 3.** *CT-scan of a patient with TAAD.*

*Current and Future Management Strategies of Type A Aortic Dissection DOI: http://dx.doi.org/10.5772/intechopen.93015*

5.Trans-oesophageal echocardiography (TEE; **Figure 4**)

TEE is portable, less invasive and has sensitivity and specificity approximately 100% [16]. It provides information about:

a.The dissection flap and false lumen in ascending aorta

b.The entry site of tear using colour Doppler


e.Pericardial effusion and tamponade

f. Aortic regurgitation and anatomy of aortic root

g.Has a better window than TTE to visualise aortic arch and descending aorta

h.Pleural effusion

*Advances in Complex Valvular Disease*

and specificity is excellent [15]

*Chest X-ray of a patient with ATAD showing a widened mediastinum.*

d.Planning the site of cannulation

entry site and functional status of the heart.

3.**ECG** may show ST-T changes especially in right coronary territory, nonspecific changes of left ventricle hypertrophy, pericardial effusion

b.Identification of the site of the intimal tear The extent of the dissection

Limitations of CT-scanning include not providing information about dissection

c.Arch vessel and thoracic and abdominal branch vessel involvement

The following information may be provided from a CT-scan:

a.Detection of the true and false lumen in the dissected aorta

4.**CT scan** (**Figure 3**): the most reliable diagnostic tool for acute aortic dissection. It is available in almost every hospital and can be rapidly performed. Sensitivity

**64**

**Figure 3.**

**Figure 2.**

*CT-scan of a patient with TAAD.*

Limitations include difficulty in visualisation of the proximal arch due to the interposition of bronchial air [17].
