Should This Gorilla Be on Lipitor? Echocardiographic Identification of Patients at Risk for Aortic Dissection
Echocardiography plays an important role in identifying risk factors for aortic dissection in humans. Transesophageal echocardiography (TEE) in particular permits close inspection of the descending and ascending aorta, the left ventricular wall thickness, and the aortic valve. TEE may be used as a means of screening adult gorillas for markers of risk for aortic dissection. Previous investigations have identified the following as important factors in the pathogenesis of aortic dissection in gorillas: hypertension, atherosclerosis, elevated cholesterol, and pregnancy. TEE can be used to identify the presence or absence of some risk factors. Left ventricular hypertrophy (as a marker for poorly controlled systemic hypertension), aortic atherosclerotic plaque, aortic dilatation, aortic valve insufficiency, and intramural hematoma can all be identified by TEE. The risk of dissection can be reduced with appropriate medical therapy if patients with increased risk are appropriately identified. The potential for prevention underscores the important role for TEE in the routine screening of gorillas. While there are technical diagnostic challenges including the limitations of echocardiographic imaging, the acquired information may be used to implement preventive medical therapies for affected animals.
The authors would like to thank Dr. Aman Mahajan and Dr. Ilana Kutinsky for their contributions to this project.
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