Aortic intramural hemorrhage visualized by transesophageal echocardiography: Findings and prognostic implication

Mohr-Kahaly, Susanne; Epbel, Raimund; Kearney, Peter; Puth, Maria; Meyer, Jürgen

doi:10.1016/0735-1097(94)90751-x

Cited by 265 publications

(182 citation statements)

References 17 publications

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“…Initial tomographic imaging was performed by random use of transesophageal echocardiography (TEE), contrastenhanced x-ray computed tomography (CT), and MRI. All cases with IMH on initial images were confirmed by additional tomographic modalities 1,[12][13][14] ; discordant diagnostic findings were resolved by a third independent imaging procedure in 7 patients. Imaging was completed within 24 hours of hospital admission.…”

Section: Patientsmentioning

confidence: 91%

“…12,14 IMH was diagnosed in absence of a dissecting membrane, intimal disruption, or false lumen flow but in presence of regional aortic wall thickness Ͼ7 mm in circular or crescent shape caused by intramural accumulation of blood. 1,[12][13][14] …”

Section: Diagnostic Imagingmentioning

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.…”

mentioning

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%

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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: Patientsmentioning

confidence: 91%

Section: Diagnostic Imagingmentioning

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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“…Acute aortic intramural hemorrhage is a variant or a precursor [1][2][3][4][5] of acute classic aortic dissection, without intimal tear and flow communication. Intramural hemorrhage has been reported with increasing frequency with the development of modern diagnostic imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Prognosis of Acute Aortic Intramural Hemorrhage Compared with Those of Acute Aortic Dissection. A Single Center Experience.

et al. 2001

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SUMMARYThe clinical manifestations and natural history of acute aortic intramural hemorrhage are not well characterized. Therefore, we have evaluated the differences in the clinical features and prognosis between acute intramural hemorrhage and acute classic aortic dissection.One hundred two consecutive patients with acute aortic syndrome were diagnosed between November 1994 and May 1999. The clinical features, treatment modalities and survival of these patients were analyzed.Thirty one of the 102 patients (30%) had intramural hemorrhage and 71 (70%) had aortic dissection. Patients with intramural hemorrhage were older than those with aortic dissection (mean ages 67 and 55 years, respectively) (p < 0.001), and intramural hemorrhage showed a lower proportion of type A than did aortic dissection (32% and 58%, respectively) (p = 0.018). The incidence of severe complications was significantly lower in patients with intramural hemorrhage than in those with aortic dissection (19% and 27%, respectively) (p < 0.001). Mean follow-up duration was 23.1 ± 16.0 months.The overall death rate for patients with intramural hemorrhage (2 / 31; 6%) tended to be lower than those with aortic dissection (14 / 71; 20%) (p = 0.104). The Stanford classification and treatment modalities were not correlated with death. Late follow-up imaging studies in intramural hemorrhage showed partial to complete resolution of intramural hematoma (9/15; 60%).In this study, intramural hemorrhage was fairly common, more frequent among older patients, had a lower proportion of type A, and showed a lower incidence of severe complications and a more favorable prognosis in terms of mortality, than aortic dissection. (Jpn Heart J 2001; 42: 91-100)

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Transesophageal Echocardiography of the Aorta

Blanchard

Kimura²,

Dittrich³

et al. 1994

JAMA

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Transesophageal echocardiography (TEE) has become a widely used imaging technique for evaluating cardiac structure, function, and valvular anatomy. Transesophageal echocardiography has also provided a new perspective on the thoracic aorta, and there is growing evidence that the technique contributes valuable and sometimes unique information about aortic structure and pathology. Recently introduced multiplane transesophageal probes have improved visualization of the proximal and transverse aorta, but few comprehensive discussions of TEE's application in aortic disease exist. Therefore, we have reviewed the published literature and our institutional experience in transesophageal aortic ultrasonography. The available evidence strongly supports the use of TEE in aortic dissection and atherosclerosis and suggests potential utility in additional diseases of the aorta such as aneurysm, ulceration, trauma, and congenital or inherited malformation.

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Aortic intramural hemorrhage visualized by transesophageal echocardiography: Findings and prognostic implication

Abstract: Intramural hemorrhage represents a variant of aortic dissection and may be an early finding in patients who develop classic aortic dissection or rupture. Transesophageal echocardiography is an excellent method for the detection of intramural hemorrhage and for monitoring these patients.

Cited by 265 publications

References 17 publications

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

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

Clinical Features and Prognosis of Acute Aortic Intramural Hemorrhage Compared with Those of Acute Aortic Dissection. A Single Center Experience.

Transesophageal Echocardiography of the Aorta

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