[Role of noninvasive graphic diagnosis in acute type A aortic dissection and selection of the adjunct for cerebral protection].

We have evaluated the usefulness of graphic diagnostic modalities (transthoracic echocardiography [TTE], high speed CT, transesophageal echocardiography [TEE], surface echocardiography [SE]) in acute type A aortic dissection and selected the adjunct to protect cerebral damage during operation followed by pre and intraoperative diagnosis. 1) Angiopraphy was undergone in only 5 cases of 22 cases of acute type A dissection. Intimal flap of the ascending aorta was completely diagnosed by TTE and CT. It was sometimes difficult to show the location of the intimal tear by TTE and CT (diagnostic sensitivity 64%, specificity 88%). However, TEE and SE showed the location of intimal tear in all cases (sensitivity 100%, specificity 100%) and also clarified the dissection of the coronary arterial orifice. CT and SE were useful to detect dissection of the cervical branches. 2) The adjunct for cerebral protection was selected by the diagnosis of the distension of the dissection. Retrograde cerebral perfusion was used in the cases with intimal tear in the ascending aorta (10 cases) and selective cerebral perfusion was selected in cases of the distended dissection, in which dissection involved the arch aorta and replacement of aortic arch was required (12 cases). Cerebral perfusion time and operative mortality was 48 min and 10% in the former and 72 min and 17% in the latter, respectively. Operative mortality was not different in both groups.