Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

Song, Jae-Kwan; Yim, Ji Hye; Ahn, Jung‐Min; Kim, Dae–Hee; Kang, Joon‐Won; Lee, Taek Yeon; Song, Jong–Min; Choo, Suk Jung; Kang, Duk–Hyun; Chung, Cheol Hyun; Lee, Jae Won; Lim, Tae‐Hwan

doi:10.1161/circulationaha.109.879783

Cited by 181 publications

(185 citation statements)

References 33 publications

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“…This difference may explain the higher risk of rupture and progression to AD for IMH (23)(24)(25). IMH more commonly involves the descending aorta whereas AD more commonly involves the ascending aorta (24,26,27). The mechanism by which an IMH is created is still not clearly elucidated.…”

Section: Intramural Hematoma (Imh)mentioning

confidence: 99%

Acute aortic syndrome

Corvera

2016

Ann. Cardiothorac. Surg.

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Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another.

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Section: Intramural Hematoma (Imh)mentioning

confidence: 99%

Acute aortic syndrome

Corvera

2016

Ann. Cardiothorac. Surg.

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“…Intramurales Hämatom | Beim komplizierten Typ-A-IMH mit Perikarderguss, periaortalem Häma-tom und großen Aneurysmen ist eine Notfall-OP indiziert -ansonsten eine dringliche OP innerhalb von 24 Stunden [10]. Bei älteren oder multimorbiden Patienten, ohne Vorliegen einer Aortendilatation über 50 mm und einer IMH-Dicke kleiner als 11 mm, kann man zunächst auch zuwartend, medikamentös-supportiv therapieren [32,54].…”

Section: Tab 2 Symptome Und Komplikationen Des Aas (Nach [10])unclassified

Akutes Aortensyndrom

Wurster

Riessen

Haap

2015

Dtsch med Wochenschr

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Das akute Aortensyndrom (AAS) ist zwar seltener, aber nicht weniger bedrohlich als die beiden anderen wichtigen Ursachen des akuten Thoraxschmerzes. Bei vier von fünf Patienten mit AAS liegt eine klassische Aortendissektion zugrunde; transmurale Hämatome oder penetrierende atheromatöse Ulzera kommen ebenfalls vor. Auch in diesen Fällen gilt es, rasch die Symptome und Befunde richtig einzuordnen und die -meist operative -Therapie zu initiieren.

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“…IMH and aortic dissection share similar risk factors, and are classified the same way as Stanford type A and type B. Ascending aorta IMH may cause aortic regurgitation, hemopericardium or aortic rupture. Predictors of adverse outcomes include syncope, enlarged aorta diameter ([55 mm) and increased hematoma thickness ([16 mm) [1]. PAU often has a variable degree of IMH.…”

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confidence: 99%

“…PAU accounts for 2-7 % of symptomatic patients with suspected acute aortic syndrome, and an IMH can be identified in approximately 6 % of aortic dissections [2,3]. Noncontrast enhanced CT scan with a high attenuation crescent sign provides a tool for differential diagnosis of an acute aortic syndrome as well as prognostic information [1,4].…”

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confidence: 99%

Type A intramural hematoma and hemopericardium secondary to penetrating atherosclerotic ulcer

et al. 2015

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A 65-year-old woman presented with syncope after having breakfast. She reported dizziness and blackout like symptoms before the syncope episode; however, the neurologic examination showed no evidence of hemiplegia or other neurologic residue. The brain computed tomography (CT scan) revealed no evidence of intracranial hemorrhage or stroke lesion. The patient collapsed with presentation of shock and altered consciousness 2 h after arriving at the emergency department. The physical examination revealed hypotension and engorged jugular veins. Emergent wholebody CT scan was performed, and the noncontrast-enhanced CT scan showed a high attenuation crescent sign in the ascending aortic wall consistent with an intramural hematoma (IMH), and filling of the pericardium consistent with an intramural hemopericardium (Fig. 1a). Contrastenhanced CT scan demonstrated low attenuation of the ascending aortic wall and a penetrating atherosclerotic ulcer (PAU) in the aortic root (Fig. 1b). The patient received emergent ascending aorta grafting surgery. The postoperative period was uneventful, and the patient recovered well.IMH with PAU of aorta are included in the acute aortic syndromes as aortic dissection variants. IMH and aortic dissection share similar risk factors, and are classified the same way as Stanford type A and type B. Ascending aorta IMH may cause aortic regurgitation, hemopericardium or aortic rupture. Predictors of adverse outcomes include syncope, enlarged aorta diameter ([55 mm) and increased hematoma thickness ([16 mm) [1]. PAU often has a variable degree of IMH. Patients with type A IMH with PAU should have early surgery, if possible, since they are at high risk for dissection, rupture, aortic regurgitation, cardiac tamponade, or myocardial infarction. PAU accounts for 2-7 % of symptomatic patients with suspected acute aortic syndrome, and an IMH can be identified in approximately 6 % of aortic dissections [2,3]. Noncontrast enhanced CT scan with a high attenuation crescent sign

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Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

Cited by 181 publications

References 33 publications

Acute aortic syndrome

Acute aortic syndrome

Akutes Aortensyndrom

Type A intramural hematoma and hemopericardium secondary to penetrating atherosclerotic ulcer

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