Clinical analysis of acute type A intramural hematoma: comparison between two different pathophysiological types

The Annals of Thoracic Surgery
Kunihide NakamuraKazushi Kojima

Abstract

Type A intramural hematoma (IMH) has two different etiologies, which are rupture of vasa vasorum and penetrating atherosclerotic ulcer (PAU); however, it is difficult to know which is the initiating event. Between January 1993 and August 2004, 28 patients of acute type A IMH were treated in our department and were divided into two groups, 20 patients with IMH probably caused by rupture of vasa vasorum (non-PAU group) and 8 patients with IMH probably caused by PAU (PAU group), according to pathologic specimen and atherosclerotic findings on computed tomography. Background factors, radiographic findings, and prognosis were analyzed retrospectively. Surgery was performed in 15 patients (75%) in non-PAU group and 4 patients (50%) in PAU group during the first admission. Late progression was noted in 3 patients, and operation was required. Finally, operation was performed in 22 patients (78.6%). The history of myocardial infarction (p = 0.026) and chronic renal failure (p = 0.026) were more associated with PAU group than with non-PAU group. Ascending aortic diameter at the onset was significantly larger in non-PAU group (50.3 +/- 6.6 mm) than in PAU group (43.9 +/- 9.0 mm; p = 0.046), and there were significantly more ulcer lesions ...Continue Reading

Citations

Aug 22, 2007·Clinical Nuclear Medicine·Alex RyanTodd M Blodgett
Aug 22, 2009·AJR. American Journal of Roentgenology·Melissa S BosmaJames D Myles
Sep 30, 2010·The International Journal of Cardiovascular Imaging·Choong Wook LeeTae-Hwan Lim
Jul 31, 2007·The Journal of Thoracic and Cardiovascular Surgery·Alex RyanTodd M Blodgett
Feb 23, 2008·The Annals of Thoracic Surgery·Tomoki ShimokawaTsuyoshi Itoh
Jul 7, 2007·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Jamie M PelzelKevin M Harris
Aug 20, 2010·Asian Cardiovascular & Thoracic Annals·Sadanari SawakiMasato Usui
Aug 24, 2017·Echocardiography·De-Li ZhaoJin-Ling Zhang

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