Type A Intramural Hematoma

Isselbacher, Eric M.

doi:10.1016/j.jaccas.2020.05.053

Cited by 1 publication

(4 citation statements)

References 12 publications

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“…TAIMH is less likely to be associated with acute aortic insufficiency, coronary artery involvement or aortic root dilation [3]. However, the risk of rupture remains quite high, between 5% and 25% [3,6,7]. Regarding aneurysm formation, 20–35% of medically treated patients with TAIMH experience resolution during follow-up, without any further intervention [8–10].…”

Section: Natural Coursementioning

confidence: 99%

“…During the initial year after TAIMH presentation, it may stabilize or regress in half of patients, while in a proportion of 5–25% will evolve to typical dissection [3,5 ▪ ,6]. TAIMH is less likely to be associated with acute aortic insufficiency, coronary artery involvement or aortic root dilation [3].…”

Section: Natural Coursementioning

confidence: 99%

“…Furthermore, patients, including diabetics with TAIMH, under best medical treatment presented lower early mortality compared to patients that underwent urgent surgery, with an estimated rate at 4.5% and 11.1%, respectively [1,10,20,21]. A strict imaging protocol should be followed in the ‘watch and wait’ approach with serial CT angiography at days 1, 3, 7, and 14 after symptoms onset [6]. As previously noted, imaging findings as ulcer like lesions, aortic diameter or pericardial effusion have been detected as independent risk factors for aorta related adverse events and need for urgent intervention [1].…”

Section: Indications and Risk Stratificationmentioning

confidence: 99%

“…High clinical suspicion and advanced imaging modalities offer rapid and effective TAIMH diagnosis while endovascular management gains further popularity as it provides encouraging early and long-term outcomes [42,43]. However, selected uncomplicated cases may benefit from medical management and a ‘watch and wait’ approach while urgent treatment is indicated in complicated cases [6]. Specific clinical and anatomic criteria should be used to assist an individualized decision making [22,24].…”

Section: Future Perspectivesmentioning

confidence: 99%

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Ascending aortic intramural hematoma: current concepts

Nana

Kouvelos

Σπανός

2022

Current Opinion in Cardiology

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Purpose of reviewType A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.Recent findingsRecent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.SummaryDespite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.

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Section: Natural Coursementioning

confidence: 99%

Section: Natural Coursementioning

confidence: 99%