Prediction of Progression or Regression of Type A Aortic Intramural Hematoma by Computed Tomography

Kaji, Shuichiro; Nishigami, Kazuhiro; Akasaka, Takashi; Hozumi, Takeshi; Takagi, Tsutomu; Kawamoto, Takahiro; Okura, Hiroyuki; Shono, Hiroyuki; Horibata, Yoko; Honda, Takashi; Yoshida, Kiyoshi

doi:10.1161/01.cir.100.suppl_2.ii-281

Cited by 126 publications

(151 citation statements)

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“…Considering an early death rate of 20% and a 5-year survival of 43%, our findings are supported by the global experience in 456 cases of IMH with an early death rate of 16%, whereas 5-year survival rates are not available. [1][2][3][4][5][6][7][8][9][10][11] In contrast to classic evolution to overt dissection, contained rupture from disintegration of outer layers of the aortic media developed in 17 of 39 patients as another form of IMH progression (43%). Moreover, 9 patients developed aneurysm at the site of IMH and had surgical repair before dissection or rupture (23%).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, some Asian series reported low death rates in proximal IMH with medical therapy. [7][8][9][10][11] However, in fact, 10 of 22 type A IMH (45%) needed early surgery between 7 and 13 days of diagnosis and 4 cases developed cardiac tamponade requiring pericardiocentesis before medical treatment. 7 Cardiac tamponade was also observed in 2 of 3 type A IMH patients subjected to medical management, whereas death was reported in 3 cases of proximal aortic involvement.…”

Section: Prediction Of Early Progressionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, progression of IMH both to overt dissection and rupture of the aorta is unpredictable, and strategies for therapeutic management are not established. For instance, whereas blood pressure control using ␤-adrenergic receptor blockers is widely accepted for treating IMH, surgical repair of proximal IMH (type A) is not yet recognized as therapeutic standard for prevention of serious complications.…”

mentioning

confidence: 99%

“…For instance, whereas blood pressure control using ␤-adrenergic receptor blockers is widely accepted for treating IMH, surgical repair of proximal IMH (type A) is not yet recognized as therapeutic standard for prevention of serious complications. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Thus, this multicenter study was conducted to assess predictors of progression both early and late after diagnosis of IMH.…”

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confidence: 99%

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Intramural hematoma of the aorta: predictors of progression to dissection and rupture

Kodolitsch¹,

Csösz²,

Koschyk³

2003

ACC Current Journal Review

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Background-Aortic intramural hematoma (IMH) is a variant of overt aortic dissection. The predictors of progression of IMH to dissection and rupture are still unknown, and strategies for management are not established. Methods and Results-A multicenter study was conducted comprising 66 patients with IMH and hospital admission Յ48 hours after onset of initial symptoms. Among these, progression to aortic dissection or rupture occurred in 30 (45%) and death occurred in 13 (20%) patients within 30 days. Late progression was noted in 14 (21%) and death in 11 (17%) patients, yielding a 1-, 2-, and 5-year survival of 76%, 73%, and 43%, respectively. In a set of 9 variables, multivariate analysis identified IMH location in the ascending aorta (type A; Pϭ0.02) and moderately ectatic aortic diameters (49Ϯ13 mm with progression versus 57Ϯ16 mm without progression; Pϭ0.03) as independent predictors of early progression. In type A IMH, early mortality was 8% with swift surgery versus 55% without surgery (Pϭ0.004). The risk of late progression of IMH was independently associated with age at index diagnosis (Pϭ0.01) and absence of ␤-blocker therapy during follow-up (Pϭ0.03). Kaplan-Meier analysis confirmed improved 1-year survival of IMH with ␤-blocker therapy (95% versus 67% without ␤-blockers; Pϭ0.004). Conclusions-Regardless of aortic diameter, IMH of the ascending aorta (type A) is at high risk for early progression, and, thus, undelayed surgical repair should be performed. Moreover, oral ␤-blocker therapy may improve long-term prognosis of IMH independent of anatomical location.

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Section: Discussionmentioning

confidence: 99%

Section: Prediction Of Early Progressionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intramural hematoma of the aorta: predictors of progression to dissection and rupture

Kodolitsch¹,

Csösz²,

Koschyk³

2003

ACC Current Journal Review

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“…De modo geral, pode-se considerá-lo uma condição tão potencialmente catastrófica quanto a DAA e inferir que a mortalidade seja significativa -20 a 80% [114][115][116] , que a evolução para dissecção verdadeira deva ocorrer em 15 a 41% dos casos [117][118][119][120] , a ruptura em 5 a 26% dos pacientes, e a evolução para cura espontânea, de forma variável 121,122 . Em um levantamento prospectivo recente de 360 casos de dissecções aórticas agudas, Nienaber e cols.…”

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