Correspondence

Surgery of the Thoracic Aorta

N Engl J Med 1997; 337:1475-1476November 13, 1997

Article

To the Editor:

The excellent review article by Kouchoukos and Dougenis (June 26 issue)1 on surgery of the thoracic aorta did not mention the utility of gadolinium-enhanced, three-dimensional magnetic resonance angiography,2 perhaps because the most recent article they cited from the radiologic literature was from 1994. This technique provides surgically pertinent angiographic images (Figure 1Figure 1Gadolinium-Enhanced, Three-Dimensional Magnetic Resonance Angiogram Showing an Aneurysm of the Aortic Arch (Arrow) as Well as a Concomitant Atherosclerotic Ulcer (Arrowhead).) without the potential morbidity associated with conventional catheter angiography and can be performed safely in patients with severe renal insufficiency. Gadolinium-enhanced, three-dimensional magnetic resonance angiography has supplanted conventional angiography in many institutions for the preoperative evaluation of thoracoabdominal aneurysms. In conjunction with transesophageal echocardiography, it provides a comprehensive evaluation of aortic dissection and aneurysms of the ascending aorta.

Glenn Krinsky, M.D.
New York University Medical Center, New York, NY 10016

2 References

1. 1

   Kouchoukos NT, Dougenis D. Surgery of the thoracic aorta. N Engl J Med 1997;336:1876-1888
   Full Text | Web of Science | Medline

2. 2

   Prince MR, Narasimham DL, Jacoby WT, et al. Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR Am J Roentgenol 1996;166:1387-1397
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We thank Dr. Krinsky for providing information on the role of gadolinium-enhanced, three-dimensional magnetic resonance angiography in the diagnosis of diseases of the thoracic aorta. In our article, we wished to emphasize the diagnostic studies that are widely available and widely used. Newer techniques, such as gadolinium-enhanced magnetic resonance angiography, may ultimately replace them. Nevertheless, magnetic resonance angiography, with or without gadolinium enhancement, is costly, may require more time to complete, is less accessible to patients who are connected to ventilators and monitoring devices, has more limitations at the aortic root and in the descending aorta adjacent to the heart, and is less readily available than computed tomography and aortography at the present time. At our center, gadolinium-enhanced magnetic resonance angiography is currently used when conventional magnetic resonance angiography and other diagnostic studies are inconclusive.

Nicholas T. Kouchoukos, M.D.
Dimitrios Dougenis, M.D.
Missouri Baptist Medical Center, St. Louis, MO 63131