| BackgroundThe treatment of aortic diseases has made great progress in the last few decades.In particular，advances in surgical treatment and minially invasive interventional techniques have greatly improved the survival rate and quality of life of patients after surgery.However,aortic diseases,especially acute aortic dissection and interstitial hematoma,remain the leading cause of death and disability in patients with aortic disease.Aortic diameter is a very important indicator in the treatment of aortic disease.It is not only the basis for selecting the size of aortic vascular and aortic stents during surgery,but also related to the development of aortic-related complications after surgery.In the process of selecting the diameter of the aorta,if the diameter of the aorta is selected to be small,it is easy to cause intraoperative artificial blood vessel mismatch or aortic stent displacement,internal hemorrhoids.If the diameter of the aorta is selected to be large,it is easy to cause postoperative operation.Anastomotic fistulas and stent-damaged aorta form new aneurysms or dissections.Many studies have shown that the diameter of the aorta changes periodically during the cardiac cycle.At present,the commonly used clinical methods for measuring aortic diameter include transthoracic echocardiography,ct angiography,nuclear magnetic resonance,transesophageal echocardiography,and aortic angiography.These measurement methods are not able to accurately reflect the changes in the diameter of the aorta during the cardiac cycle.There is currently insufficient specialized research on changes in aortic diameter during the cardiac cycle.We performed intraoperative echocardiography for dynamic continuous measurement of aortic diameter and focused on the relationship between aortic diameter arterial changes and computed tomography angiography(CTA)and transthoracic echocardiography(TTE).Methods and resultsConsecutive adult(non-aneurysmal)patients being surgically treated for heart disease(mean age 51±11 years,range 29-76,n＝25)were included in this study.All patients underwent transthoracic echocardiography(TTE),computed tomography angiography CTA and intraoperative ultrasonography(IOUS).Anteroposterior diameters were measured at 1 cm above the junction of the aortic sinus,the proximal 1 cm of the innominate artery and the midpoint of the two.Results:The average diameter of the proximal Asc in systole/diastole measured by IOUS was 32.07±2.03/30.27±2.O5mm(paired t-test:difference:1.80±0.46mm,p<.001).The average diameters of the proximal Asc measured by non-ECG-gated CTA and TTE were 31.45±1.97 mm.and 29.7±1.84 mm,respectively.The average diameter of the mid-and distal Asc in systole/diastole measured by IOUS was 32.35±1.95/30.57±1.94 mm(paired t-test:difference:1.78±0.44mm,p<.001)and 32.32±1.92/30.67±1.90 mm(paired t-test:difference:1.65±0.42mm,P<.001),respectively.The average diameter of the mid-and distal Asc measured by CTA was 31.74±1.92 mm and 31.59±1.96 mm,respectively.At each location,the difference in the aortic diameter between systole and diastole was statistically significant(All P-values<.001;paired t-test).The minimum and maximum changes in the diameter between systole and diastole were 1.03 mm and 2.53 mm.In all,96%(24/25)of the average diameters derived from IOUS and CTA at the three locations were within the concordance limit in systole,and 92-100%(23/25 to 25/25)were within the concordance limit in diastoles.The average diameter derived from IOUS and TTE image of the proximal-Asc were within the bounds of the concordance limit 92%(23/25)of the time in systole and 100%(25/25)of the time in diastole.The average diameters derived from CTA and TTE image of the proximal-Asc were within the bounds of the concordance limit 88%(22/25)of the time.Pearson correlation coefficients between the above groups ranged from 0.905 to 0.982(All P-values<·01).ConclusionsThe Asc diameter measured by non-electrocardiographic(ECG))-gated CTA and TTE were consistent with the IOUS measurements. |
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