Pathologic Characteristics and Surgical Indications of Superacute Type A Intramural Hematoma

Uchida, Keiji; Imoto, Kiyotaka; Takahashi, Masato; Suzuki, Shinichi; Isoda, Susumu; Sugiyama, Mitsugi; Kondo, Jiro; Takanashi, Yoshinori

doi:10.1016/j.athoracsur.2004.11.017

Cited by 56 publications

(43 citation statements)

References 13 publications

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“…Besides the possibility of higher incidence of death before diagnosis in patients with AD and tamponade, the higher frequency of pericardial and pleural effusion in IMH patients could be explained partly by the more eccentric location of IMH (toward the adventitia), associated with an increased tendency to extravasation. 2,7,14 Apart from international heterogeneity in the relative prevalence of type A IMH, geographic difference in clinical outcome with medical treatment and a role for urgent surgical intervention remain challenging issues. 12 European investigators have reported very high mortality rates after medical treatment alone and have advocated urgent surgery, 2,3,15,16 whereas studies in Japan and Korea showed comparable outcomes in the absence of urgent surgery.…”

Section: Type a Imh: Clinical Features And Natural History With Medicmentioning

confidence: 99%

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

et al. 2009

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Background-The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications. .56). The 1-, 2-, and 3-year survival rates of IMH patients were 87.6Ϯ3.6%, 84.9Ϯ3.7%, and 83.1Ϯ4.1%, respectively. There was no statistical difference of overall survival rates between patients with IMH and surgically treated AD patients (Pϭ0.787). Conclusions-The clinical outcome of IMH patients receiving treatment by our policy was comparable to that of surgically treated AD patients. However, adverse clinical events were not uncommon with medical treatment alone, and initial aorta diameter and hematoma thickness may identify patients who might benefit from urgent surgery.

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Section: Type a Imh: Clinical Features And Natural History With Medicmentioning

confidence: 99%

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

et al. 2009

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“…The clinical presentation of IMH is similar to AD, however pain is often more common in IMH (22,24,26). Malperfusion and aortic valvular insufficiency is less common in IMH.…”

Section: Intramural Hematoma (Imh)mentioning

confidence: 78%

“…Pathologically, there is a difference in the location of the cleavage plane within the aortic media of an IMH when compared to an AD. The outer media (toward the adventitia) of the IMH is thinner than that of AD (22). This difference may explain the higher risk of rupture and progression to AD for IMH (23)(24)(25).…”

Section: Intramural Hematoma (Imh)mentioning

confidence: 83%

“…Periaortic hematoma is more common in IMH versus AD. There is a pericardial effusion in 60-70% of type A IMH, more common than in AD (22,24,26,27). TTE and TEE may not be diagnostic for IMH.…”

Section: Intramural Hematoma (Imh)mentioning

confidence: 99%

“…Patients with IMH are older, more commonly present with aortic aneurysm and rarely occur in patients with Marfan syndrome (22,24,25,27). Females can have IMH more often than males in contradistinction to AD (23,27).…”

Section: Intramural Hematoma (Imh)mentioning

confidence: 99%

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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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Clinical Management of Diseases of the Aorta

Sundt

2009

Evidence‐Based Cardiology

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Pathologic Characteristics and Surgical Indications of Superacute Type A Intramural Hematoma

Cited by 56 publications

References 13 publications

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

Acute aortic syndrome

Clinical Management of Diseases of the Aorta

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