753-5 Role of Transesophageal Echocardiography in the Diagnosis and Management of Traumatic Rupture of the Aortic Isthmus

A comprehensive description of transesophageal echocardiographic (TEE) findings associated with traumatic aortic rupture (TAR) is still lacking. To correlate TEE and anatomic findings, a prospective study was conducted in 29 consecutive patients suffering from blunt chest trauma and suspected TAR. Confirmation of the diagnosis of TAR was obtained by either aortography, surgery, or necropsy in all patients. TEE studies were performed during the first day of admission using a monoplane probe. TEE studies and aortograms were reviewed by independent experienced observers. The diagnosis of subadventitial TAR was made in 9 patients and intimal tears in 2 patients (one confirmed and one missed by aortography). Subadventitial TAR appeared as an abnormal thick structure composed of intima and media, and mobile within the isthmus lumen. Color flow mapping revealed no differences in blood flow velocity on both sides of the disrupted aortic wall with turbulent flow surrounding the traumatic tear. Symmetric or asymmetric localized aortic enlargement reflecting the adventitia under tension was also noted. This type of lesion requires prompt surgical repair. In contrast. intimal aortic tears appeared as very mobile thin appendages of the aortic wall. Color flow mapping demonstrated a localized mosaic of colors reflecting blood flow turbulence around the intimal laceration, Aortic diameter remained unchanged, since the tear was too small and superficial to induce adventitial distention. Since these lesions appear to regress spontaneously, conservative management and TEE follow-up was undertaken. TEE failed to diagnose a two-millimeter long medial aortic rupture with integrity of the adventitia (demonstrated at necropsy). Aortography must be obtained when the TEE study is equivocal or when a laceration of the aortic arch and the brachiocephalic arteries is suspected. Conclusions In this study, transesophageal echocardiographic and anatomic findings in patients with traumatic aortic rupture were strongly correlated. In experienced hands, TEE can be considered as an accurate firstline imaging technique for the diagnosis and management of traumatic aortic rupture.