Availability of TOE in the UK

In the UK, TOE is limited by its availability out-of-hours. Some hospitals with cardiothoracic surgery on site may perform a TOE immediately preoperatively if the clinical features are highly suggestive.

Where TOE is not immediately available, CT scanning is generally used. In the IRAD series (Insights from the International Registry of Acute Aortic Dissection) CT scanning was far more commonly used than TOE in Europe.

Where CT has been used to make the diagnosis, TTE is a useful adjunctive investigation as it will:

• Estimate the size of a pericardial effusion and whether it is causing tamponade
• Determine the presence and degree of aortic regurgitation
• Accurately measure the size of the aortic root informing the need for aortic root surgery
• Assess left ventricular systolic function