CLINICAL STUDY: AORTIC DISSECTION
Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta
Jae-Kwan Song, MD, FACC*,
Hyun-Sook Kim, MD*,
Duk-Hyun Kang, MD*,
Tae-Hwan Lim, MD ,
Meong-Gun Song, MD ,
Seong-Wook Park, MD, FACC* and
Seung-Jung Park, MD, FACC*
* Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Division of Diagnostic Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Division of Cardiac Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Manuscript received July 5, 2000;
revised manuscript received November 29, 2000,
accepted January 17, 2001.
Reprint requests and correspondence: Dr. Jae-Kwan Song, Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-040, South Korea
jksong{at}www.amc.seoul.kr
Objectives
The goal of this study was to test the hypothesis that the absence of direct flow communication through intimal tear in aortic intramural hematoma (AIH) involving the ascending aorta has different clinical impact on clinical course compared with typical aortic dissection (AD).
Background
Although emergent surgical repair has been applied for patients with proximal AIH as if it was typical AD, the natural history of proximal AIH is not known clearly yet.
Methods
Direct comparison of the clinical data of 81 patients with proximal AD and 24 patients with AIH was performed retrospectively.
Results
Patients with AIH were older (67 ± 10 vs. 50 ± 13, p = 0.001), and female gender was more predominant in AIH (19/24 vs. 29/81, p = 0.001). The development of mediastinal hemorrhage and pericardial and pleural effusion was more frequent in patients with AIH than it was in patients with AD. Although medical treatment was more frequently selected in the AIH group (75% vs. 15%, p = 0.001) due to old age and other associated medical diseases, the mortality rate with medical treatment was much lower in patients with AIH than it was in patients with AD (6% vs. 58%, p = 0.003). In follow-up imaging studies of 13 patients who survived AIH without surgical repair, seven patients showed complete resolution. Typical AD developed in three patients, and the other three patients showed focal AD only in the descending aorta. The two-year survival rate did not show significant difference (84% ± 6% in AIH vs. 76% ± 17% in AD, p = 0.47).
Conclusions
Absence of continuous flow communication can explain a more favorable clinical course of AIH than for AD, and medical treatment with frequent imaging follow-up and timed elective surgery in cases with complications can be a rational option for patients with proximal AIH.
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Abbreviations and Acronyms
| | AD | = aortic dissection | | AIH | = aortic intramural hematoma | | CT | = contrast-enhanced X-ray computed tomography | | MRI | = magnetic resonance imaging | | TEE | = transesophageal echocardiography |
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