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Journal of the American Society of Echocardiography
February 2015
Document Outline - Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the Eu ...
- Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance
- Preamble
- I. Anatomy and Physiology of the Aorta
- A. The Normal Aorta and Reference Values
- 1. Normal Aortic Dimensions
- B. How to Measure the Aorta
- 1. Interface, Definitions, and Timing of Aortic Measurements
- 2. Geometry of Different Aortic Segments: Impact on Measurements
- a. Aortic Annulus
- b. Sinuses of Valsalva and STJ
- c. Ascending Aorta and More Distal Segments
- C. Aortic Physiology and Function
- 1. Local Indices of Aortic Function
- 2. Regional Indices of Aortic Stiffness: Pulsewave Velocity (PWV)
- II. Imaging Techniques
- A. Chest X-Ray (CXR)
- B. TTE
- C. TEE
- D. Three-Dimensional Echocardiography
- E. Intravascular Ultrasound (IVUS)
- F. CT
- 1. Methodology
- a. CTA
- i. Noncontrast CT before Aortography
- ii. Electrocardiographically Gated CTA
- iii. Thoracoabdominal CT after Aortography
- iv. Exposure to Ionizing Radiation
- v. Measurements
- G. MRI
- 1. Black-Blood Sequences
- 2. Cine MRI Sequences
- 3. Flow Mapping
- 4. Contrast-Enhanced MR Angiography (MRA)
- 5. Artifacts
- H. Invasive Aortography
- I. Comparison of Imaging Techniques
- III. Acute Aortic Syndromes
- A. Introduction
- B. Aortic Dissection
- 1. Classification of Aortic Dissection
- 2. Echocardiography (TTE and TEE)
- a. Echocardiographic Findings
- b. Detection of Complications
- c. Limitations of TEE
- 3. CT
- 4. MRI of Aortic Dissection
- 5. Imaging Algorithm
- 6. Use of TEE to Guide Surgery for Type A Aortic Dissection
- 7. Use of Imaging Procedures to Guide Endovascular Therapy
- 8. Serial Follow-Up of Aortic Dissection (Choice of Tests)
- 9. Predictors of Complications by Imaging Techniques
- a. Maximum Aortic Diameter
- b. Patent False Lumen
- c. Partial False Luminal Thrombosis
- d. Entry Tear Size
- e. True Luminal Compression
- 10. Follow-Up Strategy
- C. IMH
- 1. Introduction
- 2. Imaging Hallmarks and Features
- 3. Imaging Algorithm
- 4. Serial Follow-Up of IMH (Choice of Tests)
- 5. Predictors of Complications
- D. PAU
- 1. Introduction
- 2. Imaging Features
- 3. Imaging Modalities
- a. CT
- b. MRI
- c. TEE
- d. Aortography
- 4. Imaging Algorithm
- 5. Serial Follow-Up of PAU (Choice of Tests)
- IV. Thoracic Aortic Aneurysm
- A. Definitions and Terminology
- B. Classification of Aneurysms
- C. Morphology
- D. Serial Follow-Up of Aortic Aneurysms (Choice of Tests)
- 1. Algorithm for Follow-Up
- E. Use of TEE to Guide Surgery for TAAs
- F. Specific Conditions
- 1. Marfan Syndrome
- a. Aortic Imaging in Unoperated Patients with Marfan Syndrome
- b. Postoperative Aortic Imaging in Marfan Syndrome
- c. Postdissection Aortic Imaging in Marfan Syndrome
- d. Family Screening
- 2. Other Genetic Diseases of the Aorta in Adults
- a. Turner Syndrome
- b. Loeys-Dietz Syndrome
- c. Familial TAAs
- d. Ehlers-Danlos Syndrome
- 3. BAV-Related Aortopathy
- a. Bicuspid Valve–Related Aortopathy
- b. Imaging of the Aorta in Patients with Unoperated BAVs
- c. Follow-Up Imaging of the Aorta in Patients with Unoperated BAVs
- d. Postoperative Aortic Imaging in Patients with BAV-Related Aortopathy
- e. Family Screening
- V. Traumatic Injury to the Thoracic Aorta
- A. Pathology
- B. Imaging Modalities
- 1. CXR
- 2. Aortography
- 3. CT
- 4. TEE
- 5. IVUS
- 6. MRI
- C. Imaging Algorithm
- D. Imaging in Endovascular Repair
- VI. Aortic Coarctation
- A. Aortic Imaging in Patients with Unoperated Aortic Coarctation
- B. Postoperative Aortic Imaging in Coarctation
- VII. Atherosclerosis
- A. Plaque Morphology and Classification
- B. Imaging Modalities
- 1. Echocardiography
- 2. Epiaortic Ultrasound (EAU)
- 3. CT
- 4. MRI
- C. Imaging Algorithm
- D. Serial Follow-Up of Atherosclerosis (Choice of Tests)
- VIII. Aortitis
- A. Mycotic Aneurysms of the Aorta
- B. Noninfectious Aortitis
- IX. Postsurgical Imaging of the Aortic Root and Aorta
- A. What the Imager Needs to Know
- B. Common Aortic Surgical Techniques
- 1. Interposition Technique
- 2. Inclusion Technique
- 3. Composite Grafts
- 4. Aortic Arch Grafts
- 5. Elephant Trunk Procedure
- 6. Cabrol Shunt Procedure
- 7. Technical Adjuncts
- C. Normal Postoperative Features
- D. Complications after Aortic Repair
- 1. Pseudoaneurysm
- 2. False Luminal Dilatation
- 3. Involvement of Aortic Branches
- 4. Infection
- E. Recommendations for Serial Imaging Techniques and Schedules
- X. Summary
- Notice and Disclaimer
- References
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