Therapeutic management of acute type A aortic intramural hematoma

Yang, Jing; Yu, Changjiang; Li, Xin; Kuang, Juntao; Chen, Zerui; Xiao, Fei; Sun, Tucheng; Fang, Miaoxian; Fan, Ruixin

doi:10.1186/s12872-021-02104-4

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…To date, several predictors have been repeatedly reported to be associated with adverse aortic events, such as an MAD of >45–55 mm ( 1 , 8 , 16 , 17 ) and an MHT of >8–16 mm ( 1 , 9 , 15 , 17 ). In the present study, the rate of descending aorta involvement was lower and the MAD was larger in patients with aortic events.…”

Section: Discussionmentioning

confidence: 99%

“…Multidetector-row computed tomography (CT), which is increasingly used in the diagnosis of TAIMH, provides more detailed information for clinical decision-making in TAIMH treatment. Some imaging characteristics, such as penetrating atherosclerotic ulcers (PAUs) and ulcer-like projections (ULPs) ( 13 , 14 ), enlarged aortic diameter, and increased hematoma thickness are commonly reported features associated with adverse events ( 8 , 15 – 17 ). However, these studies are limited to relatively small number of patients (<50), and clinical studies including Chinese patients with TAIMH are lacking.…”

Section: Introductionmentioning

confidence: 99%

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CT characteristics and clinical implications of acute type A aortic intramural hematoma

Yen

Lee

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesComputed tomography (CT) has been increasingly used in the diagnosis of acute aortic syndrome, and a number of high-risk CT imaging features have been reported. We aimed to identify CT imaging findings suggesting high-risk for acute aortic syndrome by examining clinical outcomes of patients with acute type A aortic intramural hematoma (TAIMH).MethodsThis retrospective study analyzed the relationship of clinical patient characteristics and imaging features with mortality and aortic events in 63 patients receiving initial medical treatment for TAIMH. Multivariate regression analysis was used to determine the predictors of aortic events, and the Kaplan–Meier method was used to analyze survival and aortic events.ResultsDuring a median follow-up of 4.2 years, 25 patients experienced aortic events and 40% of these occurred within 7 days of admission. In total, 12 patients experienced aortic death and 12 patients underwent open aortic surgery or endovascular stenting for aortic disease. In multivariate regression analysis, penetrating atherosclerotic ulcers (PAUs) or ulcer-like projections (ULPs) (P = 0.04) and pericardial effusion (P = 0.03) were independent predictors of aortic events. In the Cox regression model, PAUs/ULPs (P = 0.04) and pericardial effusion (P = 0.04) were independently associated with lower aortic event-free survival.ConclusionIdentification of high-risk CT features is important for clinical decision-making during TAIMH treatment. Early and frequent CT imaging follow-up is required in patients receiving medical treatment. PAUs/ULP and pericardial effusion were the strongest predictors of adverse aortic events.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CT characteristics and clinical implications of acute type A aortic intramural hematoma

Yen

Lee

et al. 2023

Front. Cardiovasc. Med.

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“…Blood pressure control with beta-adrenergic receptor blockade in combination with calcium channel blockers or sodium nitroprusside, to avoid reflex tachycardia, remains the first-line intervention in patients with AAS [ 13 ]. While the management of Stanford Type-A AIH is debated within the current literature, recent reviews have recorded better outcomes in those managed surgically versus medically [ 14 ]. On the other hand, Type-B AIH is regularly managed medically with hemodynamic control [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Initial Presentation of Aortic Intramural Hematoma: A Case Report and Literature Review

Coombes¹,

Moin²,

Ahmed-Khan³

et al. 2022

Cureus

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Aortic intramural hematoma (AIH) is a life-threatening emergency that involves aortic wall integrity and is characterized by either a direct rupture of the vasa vasorum or spontaneous bleeding of an arterial plaque located in the tunica media of the aortic wall. A notable difference between AIH and acute aortic dissection is the absence of an intimal flap, a finding discernable on computed tomography angiography (CTA). Followup imaging allows for the monitoring of disease progression or early findings of impending complications. While some patients may require surgical intervention, medical management with blood pressure control remains the mainstay in treatment. Our case describes a patient who was found to be in cardiac arrest secondary to ventricular fibrillation and was then found to have presumed Stanford Type A aortic dissection on CTA. After reviewing the scans, the diagnosis was reclassified to AIH due to the absence of an intimal flap, the patient was then managed medically for AIH with antihypertensive medications.

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“…We have introduced the details of establishment of cardiopulmonary bypass and cerebral perfusion in our previous research ( 14 ). All patients underwent replacement of ascending aortic and total aortic arch with an intraoperative stent inserted in the descending aorta.…”

Section: Methodsmentioning

confidence: 99%

Early and midterm results of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type a aortic dissection

Yang

Li²,

Wu³

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesWe evaluated the feasibility, effectiveness, and safety of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type A aortic dissection (ATAAD).MethodsFrom January 2016 to January 2021, 895 consecutive patients with ATAAD received surgical treatment at our hospital. After applying our exclusion criteria, 508 patients were included in this research. Based on the attending surgeon's judgment and preference, 192 patients underwent our novel surgical novel surgical technique of valve-sparing aortic root reconstruction (repair group [RG]) and 316 patients underwent the Bentall procedure (Bentall group [BG]).ResultsIn the RG, the early mortality rate was 4.2% (8/192). In the BG, the early mortality rate was 5.1% (16/316). There were no significant differences between groups. The incidence of postoperative renal failure in the BG was significantly higher than that in the RG. The mean follow-up time was 2.93 years (standard deviation, ±1.38 years). There were no significant differences between groups regarding ATAAD-related mortality and reoperation. In the RG, the rate of freedom from aortic root reoperation at 5 years was 98.2%, and the grade of aortic regurgitation 6 months later was significant less than that before surgery, and it did not worsen during later follow-up.ConclusionsValve-sparing aortic root reconstruction with a bovine pericardium patch can be successfully performed for selected patients with ATAAD and is associated with low in-hospital and late mortality rates and low root reoperation rates during early and midterm follow-up.

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Therapeutic management of acute type A aortic intramural hematoma

Cited by 5 publications

References 16 publications

CT characteristics and clinical implications of acute type A aortic intramural hematoma

CT characteristics and clinical implications of acute type A aortic intramural hematoma

A Rare Initial Presentation of Aortic Intramural Hematoma: A Case Report and Literature Review

Early and midterm results of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type a aortic dissection

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