Evaluation Of Aortic Regurgitation Caused By Stanford Type A Aortic Dissection By Two-Dimensional Transesophageal Echocardiography

Background and objective:Once Stanford type A aortic dissection involves the aortic root,complicated changes of the root anatomy and hemodynamic will occur,and it progresses quite rapidly.It is difficult to predict the changes of patient’s condition from the diagnosis to surgical operation.Perioperative application of two-dimensional transesophageal echocardiography technology can help doctors observe the patient’s disease and its progression in time,which is essential for the surgeons to understand the changes of the disease and adjust the operation method in time.In addition,twodimensional transesophageal echocardiography has important clinical application value for immediately observing the effect of surgery.The significance of intraoperative transesophageal echocardiography in judging aortic regurgitation during the surgery has been affirmed,however,there are few reports about the specific causes of regurgitation,the degree of regurgitation,the changes in the aortic root structure,the relationship between the attachment point of the dissected intimal flap and the proximal position,the choice of surgical procedures,and the comparison of the degree of regurgitation before and after aortic valve formation.The study aims to use two-dimensional transesophageal echocardiography to monitor the data related to the aortic root structure of patients with Stanford type A aortic dissection,and to explore the cause,degree,relationship with the dissected intimal flap and the formation of the Stanford type A dissection with aortic regurgitation.The results are expected to provide a theoretical basis for related issues of clinical treatment.Methods: From September 2019 to October 2020,48 patients with Stanford type A aortic dissection were selected for surgical treatment in our hospital.The clinical data measured by two-dimensional transesophageal echocardiography of above patients were collected to analyze the degree of preoperative aortic regurgitation and changes in the root structure,the relationship between the attachment point of the intimal flamp of the dissection and the proximal position,the choice of surgical procedures and the comparison of the degree of regurgitation before and after aortic valve formation.Results: 1.Stanford type A aortic dissection causes a high rate of aortic regurgitation,as high as 89.6% in this study.Assessment of the cause of aortic regurgitation by twodimensional transesophageal echocardiography was consistent with what was seen in the surgical field by 70.1%.2.There was no correlation between the degree of preoperative aortic valve regurgitation and the diameter of the aortic root,the diameter of the ascending aorta and the distance from the intimal flamp attachment point to the aortic root(P>0.05),but it was related to the diameter of the aortic sinus and sinus junction(P<0.05);3.There was statistically significance of the diameter of the valve ring,the diameter of the aortic sinus,the diameter of the sinus junction and the distance from the intimal flamp attachment point to the root of no or left coronary valve in aortic dissection between the two groups of aortic dissection intimal flamp tearing into the aortic sinus and not into the aortic sinus.(P<0.05),and there was no difference between the diameter of ascending aortic and the distance from the attachment point of the intimal flamp to the root of the right coronary valve(P>0.05);4.There was statistical significance of the preoperative degree of aortic valve regurgitation,the cause and type of regurgitation and the choice of surgical procedures between two groups of aortic dissection intimal flamp tearing into the aortic sinus and not into the aortic sinus(P<0.05);5.The degree of aortic regurgitation was related to the position of the proximal end of the intimal flamp(P < 0.05),and the most severe regurgitation occurs when the proximal end of the intimal flamp falls into the commissure of the valve leaflet;6.The evaluation of aortic regurgitation with two-dimensional transesophageal echocardiography can guide surgeons to choose the appropriate surgical procedure;in this study,the ratio of aortic valvuloplasty reached 56.2%,and the success rate was up to 96.3%.Conclusion: 1.Stanford type A aortic dissection causes a high rate of aortic regurgitation.Two-dimensional transesophageal echocardiography can clearly assess the condition and specific reasons of aortic regurgitation,which is highly consistent with what is seen in the surgical field and has irreplaceable effects and significance;2.The degree of preoperative aortic regurgitation is related to the diameter of aortic sinus and sinus junction,but not related to the diameter of other root structures;3.The degree of aortic aortic valve regurgitation is more severe when the attachment point of the dissection intimal flamp is torn into the aortic sinus;4.The degree of aortic regurgitation is related to the proximal position of the intimal flamp;5.Combining the concept of functional aortic ring,the classification of aortic valve regurgitation by two-dimensional transesophageal echocardiography can provide surgeons with specific opinions on the treatment of aortic root diseases;6.Two-dimensional transesophageal echocardiography can guide aortic valvuloplasty after assessing the aortic root,and the success rate of aortic valvuloplasty is high and the effect of aortic valvuloplasty is good.