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August 17, 1994, Vol 272, No. 7 >
ARTICLE | August 17, 1994

Transesophageal Echocardiography of the Aorta FREE

Daniel G. Blanchard, MD; Bruce J. Kimura, MD; Howard C. Dittrich, MD; Anthony N. DeMaria, MD
[+] Author Affiliations

Address correspondence to UCSD Medical Center, 200 W Arbor St, #8411, San Diego, CA 92103 (Dr Blanchard).


JAMA. 1994;272(7):546-551. doi:10.1001/jama.1994.03520070066040
Text Size: A A A
Published online
Article
References

Transesophageal echocardiography (TEE) has become a widely used imaging technique for evaluating cardiac structure, function, and valvular anatomy. Transesophageal echocardiography has also provided a new perspective on the thoracic aorta, and there is growing evidence that the technique contributes valuable and sometimes unique information about aortic structure and pathology. Recently introduced multiplane transesophageal probes have improved visualization of the proximal and transverse aorta, but few comprehensive discussions of TEE's application in aortic disease exist. Therefore, we have reviewed the published literature and our institutional experience in transesophageal aortic ultrasonography. The available evidence strongly supports the use of TEE in aortic dissection and atherosclerosis and suggests potential utility in additional diseases of the aorta such as aneurysm, ulceration, trauma, and congenital or inherited malformation.

(JAMA. 1994;272:546-551)

REFERENCES

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2 +
Matsumoto M, Oka Y, Strom J, et al.  Application of transesophageal echocardiography to continuous intraoperative monitoring of left ventricular performance. Am J Cardiol . 1980;;46:95-105.
3 +
Daniel WG, Erbel R, Kasper W, et al.  Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation . 1991;; 83:817-821.
4 +
Bansal RC, Shah PM.  Transesophageal echocardiography. Curr Probl Cardiol . 1990;;15:647-720.
5 +
Mitchell MM.  Evaluation of aortic disease.  In: Dittrich HC, ed. Clinical Transesophageal Echocardiography . St Louis, Mo: Mosby-Year Book; 1992;: 97-107.
6 +
Nishimura RA, Miller FA, Callahan MJ, Benassi RC, Seward JB, Tajik AJ.  Doppler echocardiography: theory, instrumentation, technique, and application. Mayo Clin Proc . 1985;;60:321-343.
7 +
Waggoner AD, Perez JE.  Principles and physics of Doppler. Cardiol Clin . 1990;;8:173-190.
8 +
Hirst AE Jr, Johns VJ Jr, Kime SW Jr.  Dissecting aneurysm of the aorta: a review of 505 cases. Medicine . 1958;;37:217-279.
9 +
DeBakey ME, McCollum CH, Crawford ES, et al.  Dissection and dissecting aneurysms of the aorta. Surgery . 1982;;92:1118-1134.
10 +
Daily PO, Trueblood W, Stinson EB, et al.  Management of acute aortic dissections. Ann Thorac Surg . 1970;;10:237-247.
11 +
Eagle KA, DeSanctis RW.  Aortic dissection. Curr Probl Cardiol . 1989;;14:231-278.
12 +
Erbel R, Mohr-Kahaly S, Renollet H, et al.  Diagnosis of aortic dissection: the value of transesophageal echocardiography. Thorac Cardiovasc Surg . 1987;;35:126-133.
13 +
Enia F, Ledda G, Lo Mauro R, Matassa C, Raspanti G, Stabile A.  Utility of echocardiography in the diagnosis of aortic dissection involving the ascending aorta. Chest . 1989;;95:124-129.
14 +
Singh H, Fitzgerald E, Ruttley MST.  Computed tomography: the investigation of choice for aortic dissection? Br Heart J . 1986;;56:171-175.
15 +
White RD, Lipton MJ, Higgins CB, et al.  Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography. Am J Cardiol . 1986;;57:282-290.
16 +
Ballal RS, Nanda NC, Gatewood R, et al.  Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation . 1991;;84: 1903-1914.
17 +
Nienaber CA, Spielman RP, von Kodolitsch Y, et al.  Diagnosis of thoracic aortic dissection: magnetic resonance imaging versus transesophageal echocardiography. Circulation . 1992;;85:434-447.
18 +
Manning WJ, Li W, Edelman RR.  A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med . 1993;;328:828-832.
19 +
Granato JE, Dee P, Gibson RS.  Utility of two-dimensional echocardiography in suspected aortic dissection. Am J Cardiol . 1985;;56:123-129.
20 +
Erbel R, Daniel W, Visser C, et al.  Echocardiography in diagnosis of aortic dissection. Lancet . 1989;;1:457-460.
21 +
Nienaber CA, von Kodolitsch Y, Nicolas V, et al.  The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med . 1993;;328:1-9.
22 +
Applebe AF, Walker PG, Yeoh JK, Bonitatibus A, Yoganathan AP, Martin RP.  Clinical significance and origin of artifacts in transesophageal echocardiography of the thoracic aorta. J Am Coll Cardiol . 1993;;21:754-760.
23 +
Mohr-Kahaly S, Erbel R, Kearney P, Puth M, Meyer J.  Aortic intramural hemorrhage visualized by transesophageal echocardiography. J Am Coll Cardiol . 1994;;23:658-664.
24 +
Erbel R, Oelert H, Meyer J, et al.  Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Circulation . 1993;;87:1604-1615.
25 +
Mohr-Kahaly S, Erbel R, Rennollet H, et al.  Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation . 1989;;80:24-33.
26 +
Barbant SD, Eisenberg MJ, Schiller NB.  The diagnostic value of imaging techniques for aortic dissection. Am Heart J . 1992;;124:541-543.
27 +
Blanchard DG, Dittrich HC, Mitchell M, McCann HA.  Diagnostic pitfalls in transesophageal echocardiography. J Am Soc Echocardiogr . 1992;; 5:525-540.
28 +
Ross JJ Jr, D'Adamo AJ, Karalis DG, Chandrasekaran K.  Three-dimensional transesophageal echo imaging of the descending thoracic aorta. Am J Cardiol . 1993;;71:1000-1002.
29 +
Tobler HG, Edwards JE.  Frequency and location of atherosclerotic plaques in the ascending aorta. J Thorac Cardiovasc Surg . 1988;;96:304-306.
30 +
Fazio GP, Redberg RF, Winslow T, Schiller NB.  Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease. J Am Coll Cardiol . 1993;; 21:144-150.
31 +
Fine MJ, Kapoor W, Falanga V.  Cholesterol embolization syndrome: a review of 221 cases in the English literature. Angiology . 1987;;38:769-784.
32 +
Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser M-G, Hauw J-J.  The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med . 1992;;326:221-225.
33 +
Karalis DG, Chandrasekaran K, Victor MF, Ross JJ Jr, Mintz GS.  Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol . 1991;;17:73-78.
34 +
Tunick PA, Perez JL, Kronzon I.  Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med . 1991;;115:423-427.
35 +
Hofmann T, Kasper W, Meinertz T, Geibel A, Just H.  Echocardiographic evaluation of patients with clinically suspected arterial emboli. Lancet . 1990;;336:1421-1424.
36 +
Simons AJ, Carlson R, Hare CL, Obeid AI, Smulyan H.  The use of transesophageal echocardiography in detecting aortic atherosclerosis in patients with embolic disease. Am Heart J . 1992;;123: 224-226.
37 +
Toyoda K, Yasaka M, Nagata S, Yamaguchi T.  Aortogenic embolic stroke: a transesophageal approach. Stroke . 1992;;23:1056-1061.
38 +
Amarenco P, Cohen A, Baudrimont M, Bousser M-G.  Transesophageal echocardiographic detection of aortic arch disease in patients with cerebral infarction. Stroke . 1992;;23:1005-1009.
39 +
Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer RC, Kronzon I.  Protruding atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol . 1992;;20:70-77.
40 +
Bansal RC, Pauls GL, Shankel SW.  Blue digit syndrome: transesophageal echocardiographic identification of thoracic aortic plaque-related thrombi and successful outcome with warfarin. J Am Soc Echocardiogr . 1993;;6:319-323.
41 +
Pearson AC, Labovitz AJ, Tatineni S, Gomez CR.  Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol . 1991;;17:66-72.
42 +
DeRook FA, Comess KA, Albers GW, Popp RL.  Transesophageal echocardiography in the evaluation of stroke. Ann Intern Med . 1992;;117:922-932.
43 +
Stanson AW, Kazmier FJ, Hollier LH, et al.  Penetrating atherosclerotic ulcers of the thoracic aorta. Ann Vasc Surg . 1986;;1:15-23.
44 +
Hussain S, Glover JL, Bree R, Bendick PJ.  Penetrating atherosclerotic ulcers of the thoracic aorta. J Vasc Surg . 1989;;9:710-717.
45 +
Cooke JP, Kazmier FJ, Orszulak TA.  Penetrating aortic ulcer: pathologic manifestations, diagnosis, and management. Mayo Clin Proc . 1988;;63: 718-725.
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Kazerooni EA, Bree RL, Williams DM.  Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. Radiology . 1992;;183:759-765.
47 +
Yucel EK, Steinberg FL, Egglin TK, Geller SC, Waltman AC, Athanasoulis CA.  Penetrating aortic ulcers: diagnosis with MR imaging. Radiology . 1990;;177:779-781.
48 +
Eagle KA, De Sanctis RW.  Diseases of the aorta.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;:1533-1535.
49 +
Kamp O, van Rossum AC, Torenbeek R.  Transesophageal echocardiography and magnetic resonance imaging for the assessment of saccular aneurysm of the transverse thoracic aorta. Int J Cardiol . 1991;;33:330-333.
50 +
McKenney PA, Shemin RJ, Weigers SE.  Role of transesophageal echocardiography in sinus of Valsalva aneurysm. Am Heart J . 1992;;123:228-229.
51 +
Dorsa FB, Tunick PA, Culliford A, Kronzon I.  Pseudoaneurysm of the thoracic aorta due to cardiopulmonary resuscitation: diagnosis by transesophageal echocardiography. Am Heart J . 1992;; 123:1398-1400.
52 +
Kronzon I, Demopoulos L, Schrem SS, et al.  Pitfalls in the diagnosis of thoracic aortic aneurysm by transesophageal echocardiography. J Am Soc Echocardiogr . 1990;;3:145-148.
53 +
Taams MA, Gussenhoven WJ, Bos E, Roelandt J.  Saccular aneurysm of the transverse thoracic aorta detected by transesophageal echocardiography. Chest . 1988;;93:436-437.
54 +
Greedyke RM.  Traumatic rupture of the aorta: special reference to automobile accidents. JAMA . 1966;;195:527-530.
55 +
Delrossi AJ, Cernaianu AC, Madden CD, et al.  Traumatic disruptions of the thoracic aorta: treatment and outcome. Surgery . 1990;;108:864-870.
56 +
Sturm JT, Billiar TR, Dorsey JS, et al.  Risk factors for survival following surgical treatment of traumatic aortic rupture. Ann Thorac Surg . 1985;; 39:418-421.
57 +
Marsh DG, Sturm JT.  Traumatic aortic rupture: roentgenographic indications for angiography. Ann Thorac Surg . 1976;;21:337-340.
58 +
Eddy AC, Nance DR, Goldman MA, et al.  Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography. Am J Surg . 1990;;159:500-503.
59 +
Kram HB, Wohlmuth DA, Appel PL, Shoemaker WC.  Clinical and radiographic indications for aortography in blunt chest trauma. J Vasc Surg . 1987;;6:168-176.
60 +
Galvin IF, Black IW, Lee CL, Horton DA.  Transesophageal echocardiography in acute aortic transection. Ann Thorac Surg . 1991;;51:310-311.
61 +
Goarin JP, Le Bret F, Riou B, Jacquens Y, Viars P.  Early diagnosis of traumatic thoracic aortic rupture by transesophageal echocardiography. Chest . 1993;;103:618-620.
62 +
Sparks MB, Burchard KW, Marrin CAS, Bean CHG, Nugent WC Jr, Plehn JF.  Transesophageal echocardiography: preliminary results in patients with traumatic aortic rupture. Arch Surg . 1991;; 126:711-716.
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Brooks SW, Young JC, Cmolik B, et al.  The use of transesophageal echocardiography in the evaluation of chest trauma. J Trauma . 1992;;32:761-765.
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Shapiro MJ, Yanofsky S, Trapp J, et al.  Cardiovascular evaluation in blunt thoracic trauma using transesophageal echocardiography (TEE). J Trauma . 1991;;31:835-839.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Schlüter M, Langenstein B, Poister J, et al.  Transesophageal cross-sectional echocardiography with a phased array transducer system: technique and initial clinical results. Br Heart J . 1982;;48:67-72.
2 +
Matsumoto M, Oka Y, Strom J, et al.  Application of transesophageal echocardiography to continuous intraoperative monitoring of left ventricular performance. Am J Cardiol . 1980;;46:95-105.
3 +
Daniel WG, Erbel R, Kasper W, et al.  Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation . 1991;; 83:817-821.
4 +
Bansal RC, Shah PM.  Transesophageal echocardiography. Curr Probl Cardiol . 1990;;15:647-720.
5 +
Mitchell MM.  Evaluation of aortic disease.  In: Dittrich HC, ed. Clinical Transesophageal Echocardiography . St Louis, Mo: Mosby-Year Book; 1992;: 97-107.
6 +
Nishimura RA, Miller FA, Callahan MJ, Benassi RC, Seward JB, Tajik AJ.  Doppler echocardiography: theory, instrumentation, technique, and application. Mayo Clin Proc . 1985;;60:321-343.
7 +
Waggoner AD, Perez JE.  Principles and physics of Doppler. Cardiol Clin . 1990;;8:173-190.
8 +
Hirst AE Jr, Johns VJ Jr, Kime SW Jr.  Dissecting aneurysm of the aorta: a review of 505 cases. Medicine . 1958;;37:217-279.
9 +
DeBakey ME, McCollum CH, Crawford ES, et al.  Dissection and dissecting aneurysms of the aorta. Surgery . 1982;;92:1118-1134.
10 +
Daily PO, Trueblood W, Stinson EB, et al.  Management of acute aortic dissections. Ann Thorac Surg . 1970;;10:237-247.
11 +
Eagle KA, DeSanctis RW.  Aortic dissection. Curr Probl Cardiol . 1989;;14:231-278.
12 +
Erbel R, Mohr-Kahaly S, Renollet H, et al.  Diagnosis of aortic dissection: the value of transesophageal echocardiography. Thorac Cardiovasc Surg . 1987;;35:126-133.
13 +
Enia F, Ledda G, Lo Mauro R, Matassa C, Raspanti G, Stabile A.  Utility of echocardiography in the diagnosis of aortic dissection involving the ascending aorta. Chest . 1989;;95:124-129.
14 +
Singh H, Fitzgerald E, Ruttley MST.  Computed tomography: the investigation of choice for aortic dissection? Br Heart J . 1986;;56:171-175.
15 +
White RD, Lipton MJ, Higgins CB, et al.  Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography. Am J Cardiol . 1986;;57:282-290.
16 +
Ballal RS, Nanda NC, Gatewood R, et al.  Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation . 1991;;84: 1903-1914.
17 +
Nienaber CA, Spielman RP, von Kodolitsch Y, et al.  Diagnosis of thoracic aortic dissection: magnetic resonance imaging versus transesophageal echocardiography. Circulation . 1992;;85:434-447.
18 +
Manning WJ, Li W, Edelman RR.  A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med . 1993;;328:828-832.
19 +
Granato JE, Dee P, Gibson RS.  Utility of two-dimensional echocardiography in suspected aortic dissection. Am J Cardiol . 1985;;56:123-129.
20 +
Erbel R, Daniel W, Visser C, et al.  Echocardiography in diagnosis of aortic dissection. Lancet . 1989;;1:457-460.
21 +
Nienaber CA, von Kodolitsch Y, Nicolas V, et al.  The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med . 1993;;328:1-9.
22 +
Applebe AF, Walker PG, Yeoh JK, Bonitatibus A, Yoganathan AP, Martin RP.  Clinical significance and origin of artifacts in transesophageal echocardiography of the thoracic aorta. J Am Coll Cardiol . 1993;;21:754-760.
23 +
Mohr-Kahaly S, Erbel R, Kearney P, Puth M, Meyer J.  Aortic intramural hemorrhage visualized by transesophageal echocardiography. J Am Coll Cardiol . 1994;;23:658-664.
24 +
Erbel R, Oelert H, Meyer J, et al.  Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Circulation . 1993;;87:1604-1615.
25 +
Mohr-Kahaly S, Erbel R, Rennollet H, et al.  Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation . 1989;;80:24-33.
26 +
Barbant SD, Eisenberg MJ, Schiller NB.  The diagnostic value of imaging techniques for aortic dissection. Am Heart J . 1992;;124:541-543.
27 +
Blanchard DG, Dittrich HC, Mitchell M, McCann HA.  Diagnostic pitfalls in transesophageal echocardiography. J Am Soc Echocardiogr . 1992;; 5:525-540.
28 +
Ross JJ Jr, D'Adamo AJ, Karalis DG, Chandrasekaran K.  Three-dimensional transesophageal echo imaging of the descending thoracic aorta. Am J Cardiol . 1993;;71:1000-1002.
29 +
Tobler HG, Edwards JE.  Frequency and location of atherosclerotic plaques in the ascending aorta. J Thorac Cardiovasc Surg . 1988;;96:304-306.
30 +
Fazio GP, Redberg RF, Winslow T, Schiller NB.  Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease. J Am Coll Cardiol . 1993;; 21:144-150.
31 +
Fine MJ, Kapoor W, Falanga V.  Cholesterol embolization syndrome: a review of 221 cases in the English literature. Angiology . 1987;;38:769-784.
32 +
Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser M-G, Hauw J-J.  The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med . 1992;;326:221-225.
33 +
Karalis DG, Chandrasekaran K, Victor MF, Ross JJ Jr, Mintz GS.  Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol . 1991;;17:73-78.
34 +
Tunick PA, Perez JL, Kronzon I.  Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med . 1991;;115:423-427.
35 +
Hofmann T, Kasper W, Meinertz T, Geibel A, Just H.  Echocardiographic evaluation of patients with clinically suspected arterial emboli. Lancet . 1990;;336:1421-1424.
36 +
Simons AJ, Carlson R, Hare CL, Obeid AI, Smulyan H.  The use of transesophageal echocardiography in detecting aortic atherosclerosis in patients with embolic disease. Am Heart J . 1992;;123: 224-226.
37 +
Toyoda K, Yasaka M, Nagata S, Yamaguchi T.  Aortogenic embolic stroke: a transesophageal approach. Stroke . 1992;;23:1056-1061.
38 +
Amarenco P, Cohen A, Baudrimont M, Bousser M-G.  Transesophageal echocardiographic detection of aortic arch disease in patients with cerebral infarction. Stroke . 1992;;23:1005-1009.
39 +
Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer RC, Kronzon I.  Protruding atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol . 1992;;20:70-77.
40 +
Bansal RC, Pauls GL, Shankel SW.  Blue digit syndrome: transesophageal echocardiographic identification of thoracic aortic plaque-related thrombi and successful outcome with warfarin. J Am Soc Echocardiogr . 1993;;6:319-323.
41 +
Pearson AC, Labovitz AJ, Tatineni S, Gomez CR.  Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol . 1991;;17:66-72.
42 +
DeRook FA, Comess KA, Albers GW, Popp RL.  Transesophageal echocardiography in the evaluation of stroke. Ann Intern Med . 1992;;117:922-932.
43 +
Stanson AW, Kazmier FJ, Hollier LH, et al.  Penetrating atherosclerotic ulcers of the thoracic aorta. Ann Vasc Surg . 1986;;1:15-23.
44 +
Hussain S, Glover JL, Bree R, Bendick PJ.  Penetrating atherosclerotic ulcers of the thoracic aorta. J Vasc Surg . 1989;;9:710-717.
45 +
Cooke JP, Kazmier FJ, Orszulak TA.  Penetrating aortic ulcer: pathologic manifestations, diagnosis, and management. Mayo Clin Proc . 1988;;63: 718-725.
46 +
Kazerooni EA, Bree RL, Williams DM.  Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. Radiology . 1992;;183:759-765.
47 +
Yucel EK, Steinberg FL, Egglin TK, Geller SC, Waltman AC, Athanasoulis CA.  Penetrating aortic ulcers: diagnosis with MR imaging. Radiology . 1990;;177:779-781.
48 +
Eagle KA, De Sanctis RW.  Diseases of the aorta.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;:1533-1535.
49 +
Kamp O, van Rossum AC, Torenbeek R.  Transesophageal echocardiography and magnetic resonance imaging for the assessment of saccular aneurysm of the transverse thoracic aorta. Int J Cardiol . 1991;;33:330-333.
50 +
McKenney PA, Shemin RJ, Weigers SE.  Role of transesophageal echocardiography in sinus of Valsalva aneurysm. Am Heart J . 1992;;123:228-229.
51 +
Dorsa FB, Tunick PA, Culliford A, Kronzon I.  Pseudoaneurysm of the thoracic aorta due to cardiopulmonary resuscitation: diagnosis by transesophageal echocardiography. Am Heart J . 1992;; 123:1398-1400.
52 +
Kronzon I, Demopoulos L, Schrem SS, et al.  Pitfalls in the diagnosis of thoracic aortic aneurysm by transesophageal echocardiography. J Am Soc Echocardiogr . 1990;;3:145-148.
53 +
Taams MA, Gussenhoven WJ, Bos E, Roelandt J.  Saccular aneurysm of the transverse thoracic aorta detected by transesophageal echocardiography. Chest . 1988;;93:436-437.
54 +
Greedyke RM.  Traumatic rupture of the aorta: special reference to automobile accidents. JAMA . 1966;;195:527-530.
55 +
Delrossi AJ, Cernaianu AC, Madden CD, et al.  Traumatic disruptions of the thoracic aorta: treatment and outcome. Surgery . 1990;;108:864-870.
56 +
Sturm JT, Billiar TR, Dorsey JS, et al.  Risk factors for survival following surgical treatment of traumatic aortic rupture. Ann Thorac Surg . 1985;; 39:418-421.
57 +
Marsh DG, Sturm JT.  Traumatic aortic rupture: roentgenographic indications for angiography. Ann Thorac Surg . 1976;;21:337-340.
58 +
Eddy AC, Nance DR, Goldman MA, et al.  Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography. Am J Surg . 1990;;159:500-503.
59 +
Kram HB, Wohlmuth DA, Appel PL, Shoemaker WC.  Clinical and radiographic indications for aortography in blunt chest trauma. J Vasc Surg . 1987;;6:168-176.
60 +
Galvin IF, Black IW, Lee CL, Horton DA.  Transesophageal echocardiography in acute aortic transection. Ann Thorac Surg . 1991;;51:310-311.
61 +
Goarin JP, Le Bret F, Riou B, Jacquens Y, Viars P.  Early diagnosis of traumatic thoracic aortic rupture by transesophageal echocardiography. Chest . 1993;;103:618-620.
62 +
Sparks MB, Burchard KW, Marrin CAS, Bean CHG, Nugent WC Jr, Plehn JF.  Transesophageal echocardiography: preliminary results in patients with traumatic aortic rupture. Arch Surg . 1991;; 126:711-716.
63 +
Brooks SW, Young JC, Cmolik B, et al.  The use of transesophageal echocardiography in the evaluation of chest trauma. J Trauma . 1992;;32:761-765.
64 +
Shapiro MJ, Yanofsky S, Trapp J, et al.  Cardiovascular evaluation in blunt thoracic trauma using transesophageal echocardiography (TEE). J Trauma . 1991;;31:835-839.
65 +
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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