Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enables routine ascending aortic cannulation in type A acute aortic.

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Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enables routine ascending aortic cannulation in type A acute aortic dissection Yoshito Inoue, MD, Ryuichi Takahashi, MD, Toshihiko Ueda, MD, Ryohei Yozu, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 2, Pages 354-360 (February 2011) DOI: 10.1016/j.jtcvs.2010.11.010 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Dual display of color flow imaging; long axis (A) and short axis (B) of inflow cannula located in true lumen of the ascending aorta (arrow) and color Doppler image of antegrade systemic perfusion. T, True lumen; F, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 354-360DOI: (10.1016/j.jtcvs.2010.11.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Computed tomographic scheme of dissection. A, Circular dissection: circumferential abnormal gap between intima and adventitia. B, Semicircular dissection: presence of intact portion without dissection, mostly at left lateral lesser curve, C, Aorta was punctured nearly toward short axis in cases of thrombosed false lumen deeply to reach inside the true lumen. D, Puncture was performed at a shallow angle in the direction of longitudinal axis toward aortic arch to reach the narrowed true lumen in cases of perfused false lumen. T, True lumen; F, false lumen. P, pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 354-360DOI: (10.1016/j.jtcvs.2010.11.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Dual display of epiaortic 2-dimensional (left panel) and color flow imaging (right panel) provided dynamic collapse and systolic expansion of the true lumen, evoked by valvelike motion of intimal flap of ascending aorta in a case of malperfusion (right, cranial side.) A, Primary entry tear closes during systole and antegrade true lumen flow (black arrow) is recognized. B, During diastole, primary tear opens (white arrow) and retrograde flow (black arrow) from both lumina runs toward the false lumen of the aortic root. T, True lumen; F, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 354-360DOI: (10.1016/j.jtcvs.2010.11.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Three-dimensional image of systolic expansion (A) and dyastolic collapse (B) of the true lumen of the ascending aorta in perfused false lumen during the period of pulsatile flow. T, Tue lumen; F, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 354-360DOI: (10.1016/j.jtcvs.2010.11.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Dual display of short-axis (left panel) and long-axis (right panel) color flow imaging. A, During systole, color Doppler signal shows antegrade systemic perfusion within the true lumen (arrow indicates intimal flap). B, During diastolic phase, true lumen collapses and color Doppler signal is extremely decreased in the true lumen. T, True lumen; F, false lumen. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 354-360DOI: (10.1016/j.jtcvs.2010.11.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions