Echocardiographic evaluation of the thoracic and proximal abdominal aorta
- Nelson B Schiller, MD, FACC, FRCP, FASE
Nelson B Schiller, MD, FACC, FRCP, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine and Anesthesia
- University of California, San Francisco
- Xiushui Ren, MD
Xiushui Ren, MD
- Associate Research Director, Cardiology Fellowship
- California Pacific Medical Center
- Bryan Ristow, MD, FACC, FASE, FACP
Bryan Ristow, MD, FACC, FASE, FACP
- Associate Clinical Professor of Medicine
- University of California, San Francisco
Echocardiography enables qualitative and quantitative evaluation of the thoracic and proximal abdominal aorta. Transthoracic echocardiography (TTE) provides views of the proximal ascending aorta, aortic arch and portions of the descending aorta. However, transesophageal echocardiography (TEE) rather than TTE is indicated for comprehensive imaging of the aorta, especially in the emergency evaluation of aortic dissection or traumatic rupture of the aortic isthmus. (See "Clinical features and diagnosis of acute aortic dissection" and "Transesophageal echocardiography in traumatic rupture of the aortic isthmus".)
Echocardiographic evaluation of the aorta for atherosclerotic plaque, sinus of Valsalva aneurysms, aortic dilation, and dissection will be reviewed here.
NORMAL AORTIC ROOT AND ASCENDING AORTA
The proximal ascending aorta attaches to the left ventricle at the annulus (hinge line of the aortic leaflets) and includes the aortic root (comprised of the three sinuses of Valsalva), the sinotubular junction, and the tubular ascending portion of the aorta. The aortic root is a direct continuation of the left ventricular outflow tract and is located right and posterior to the pulmonary infundibulum. The lower portion of the aortic root is connected to the muscular interventricular septum, the membranous septum, and to the mitral-aortic fibrous continuity (also known as the mitral-aortic intervalvular fibrosa).
Two-dimensional echocardiography — Transthoracic echocardiography (TTE) examination of the proximal ascending aorta is generally performed in the left parasternal long-axis view (image 1). Many sonographers limit their interrogation of the aorta to the proximal sinuses of Valsalva, missing the opportunity to more fully visualize the aorta. Moving up an intercostal interspace, moving the probe closer to the sternum, or tilting the probe cranially enables imaging of the more superior ascending aorta.
Right parasternal views, recorded with the patient in a right lateral decubitus position, may also be revealing . This method is especially useful when the aorta dilates to the right of the sternum.
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- NORMAL AORTIC ROOT AND ASCENDING AORTA
- Two-dimensional echocardiography
- - Evaluation of coronary arteries
- M-mode echocardiography
- - Abnormal aortic root motion on M-mode echocardiography
- AORTIC PLAQUE
- SINUS OF VALSALVA ANEURYSMS
- AORTIC DILATION
- Aortic dissection
- DESCENDING THORACIC AORTA AND AORTIC ARCH
- Abdominal aorta
- Transcatheter aortic valve implantation
- OTHER GREAT VESSELS
- Pulmonary artery
- Carotid arteries and subclavian vessels
- SUMMARY AND RECOMMENDATIONS