SUMMARYThe clinical manifestations and natural history of acute aortic intramural hemorrhage are not well characterized. Therefore, we have evaluated the differences in the clinical features and prognosis between acute intramural hemorrhage and acute classic aortic dissection.One hundred two consecutive patients with acute aortic syndrome were diagnosed between November 1994 and May 1999. The clinical features, treatment modalities and survival of these patients were analyzed.Thirty one of the 102 patients (30%) had intramural hemorrhage and 71 (70%) had aortic dissection. Patients with intramural hemorrhage were older than those with aortic dissection (mean ages 67 and 55 years, respectively) (p < 0.001), and intramural hemorrhage showed a lower proportion of type A than did aortic dissection (32% and 58%, respectively) (p = 0.018). The incidence of severe complications was significantly lower in patients with intramural hemorrhage than in those with aortic dissection (19% and 27%, respectively) (p < 0.001). Mean follow-up duration was 23.1 ± 16.0 months.The overall death rate for patients with intramural hemorrhage (2 / 31; 6%) tended to be lower than those with aortic dissection (14 / 71; 20%) (p = 0.104). The Stanford classification and treatment modalities were not correlated with death. Late follow-up imaging studies in intramural hemorrhage showed partial to complete resolution of intramural hematoma (9/15; 60%).In this study, intramural hemorrhage was fairly common, more frequent among older patients, had a lower proportion of type A, and showed a lower incidence of severe complications and a more favorable prognosis in terms of mortality, than aortic dissection. (Jpn Heart J 2001; 42: 91-100)
Background In patients with coronary artery disease CAD , atherosclerotic changes of carotid arteries CA often coexist with CAD itself. If the degree of carotid atherosclerosis can be estimated, it would be very helpful in the management of patients with CAD. Methods CA intima-media thickness IMT was evaluated by ultrasonography at 12 segments both proximal, middle, distal common CA, bifurcation, internal and external CA-of the extracranial CA on the 182 subjects whom underwent coronary angiograms. The subjects were divided into 4 groups according to the severity of CAD; control C, n 23 , single vessel disease , n 64 , two vessel disease , n 44 , three vessel disease , n 51. Results The means SD of maximal IMT, chosen from the 12 segments, of each group were 1.4 0.7mm C , 2.1 1.4mm , 2.2 1.2mm , and 2.9 1.7mm. The 4 groups showed significant differences between each other. The only conparison to yield unsignificant differences was between group I and group p 0.02 for C and , p 0.001 for C and , p 0.001 for C and , p 0.01 for and , p 0.04 for and. When multivariate analysis was used to assess which major risk factors for CAD age, male sex, smoking, hypertension, diabetes, cholesterol, triglycerides-and CAD groups affected CA IMT , group and increasing age were the most significant variables p 0.0001 and 0.0035, respectively. Conclusion It is necessary to evaluate the status of the extracranial carotid arterial system with
A 33-year-old woman was referred for further evaluation of anomalous left hepatic vein (LHV) drainage, which was incidentally discovered during work-up of cough and fever. A 64-multidetector computed tomographic angiography showed the isolated dual courses of the LHV draining into the left atrium (LA), inferior vena cava (IVC), hypoplastic left pulmonary artery (PA), and 3 right pulmonary veins (PV) with an absent left inferior PV ( Figure 1A-B). Middle and right hepatic veins drained into the IVC ( Figure 1A-B).This unusual venous anomaly has been explained as being due to the abnormal enlargement of the sinus venosus (the precursor of the heart) and preservation of the right subcardinal vein.1 Reference 1. Yee KF. Anomalous termination of a hepatic vein in the left atrium.
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