Clinical and Echocardiographic Outcomes of Aortic Intramural Hemorrhage Compared With Acute Aortic Dissection

Kang, Duk-Hyun; Song, Jae-Kwan; Song, Minho; Lee, Il-Soo; Song, Hyun; Lee, Jaewon; Park, Seong-Wook; Kim, You‐Ho; Lim, Tae‐Hwan; Park, Seung‐Jung

doi:10.1016/s0002-9149(97)00885-0

Cited by 65 publications

(51 citation statements)

References 14 publications

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“…[1][2][3][4][5][6][7] IMH may cause a potentially catastrophic clinical events, including the occurrence of overt aortic dissection and the rupture of aorta.…”

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confidence: 99%

Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma

et al. 2003

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Background-The long-term clinical course of patients with type B aortic intramural hematoma (IMH) and predictors for progression remains unknown. The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection (AD). The purpose of this study was to investigate long-term clinical course and predictors of progression in patients with type B IMH. Methods and Results-Clinical data were compared retrospectively between 53 patients with acute type B IMH (IMH group) and 57 patients with acute type B AD (AD group). All patients were treated initially with medical therapy. Two patients in IMH group and 14 patients in AD group underwent surgical repair because of aortic enlargement. The in-hospital mortality rate in IMH group was significantly lower than that in AD group (0% and 14%, Pϭ0.006). Mean follow-up periods were 53Ϯ43 months, which revealed 3 and 5 late deaths, respectively. Eleven patients with IMH showed progression (development of aortic dissection or aortic enlargement) in follow-up imaging study. The actuarial survival rates in IMH group were 100%, 97%, and 97% at 1, 2, and 5 years, which were significantly higher than those in AD group (83%, 79%, and 79%) (Pϭ0.009). Multivariate analysis identified age Ͼ70 years and new appearance of an ulcerlike projection as the strongest predictors of progression in patients with IMH. Conclusions-Patients

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“…[1][2][3][4][5][6][7] IMH may cause a potentially catastrophic clinical events, including the occurrence of overt aortic dissection and the rupture of aorta.…”

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confidence: 99%

Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma

et al. 2003

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“…Intramural hemorrhage has been reported with increasing frequency with the development of modern diagnostic imaging techniques. [1][2][3][5][6][7][8][9] However, the clinical manifestations and natural history of acute intramural hemorrhage are not well characterized. Therefore, considerable controversy remains about the optimal management of patients with acute intramural hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…12,15) Recently, the widespread availability of new non-invasive imaging techniques has made it possible to diagnose intramural hemorrhage before death. [1][2][3][7][8][9]16) Despite the increasing frequency of intramural hemorrhage detection, the clinical manifestations and natural course of this variant form of aortic dissection are not well recognized.…”

Section: Discussionmentioning

confidence: 99%

“…There have been several recent reports 8,9,25,26) indicating that intramural hemorrhage might be expected to have a better prognosis than aortic dissection. These reports suggest that intramural hemorrhage has a similar prognosis to non-communicating dissection, and intramural hemorrhage shows a lower incidence of complication in these studies.…”

Section: Discussionmentioning

confidence: 99%

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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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“…[3][4][5][6][7][8][9] In its early phase, several studies have shown IMH to be a very dynamic process that leads to reabsorption, classical dissection, or aortic rupture. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Recent studies using clinical and radiological findings identified prognostic markers associated with medium-term IMH progression or regression, with conflicting results. 17,18 Therefore, additional studies using a wider range of imaging techniques are required to determine the predictive factors of long-term evolution of IMH.…”

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confidence: 99%

Long-Term Follow-Up of Aortic Intramural Hematoma

Evangelista¹,

Domínguez²,

Sebastiá³

et al. 2003

Circulation

190

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Background-Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. Methods and Results-Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45Ϯ31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (PϽ0.02) and to longitudinal extension of IMH (PϽ0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH. Conclusions-The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.

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Clinical and Echocardiographic Outcomes of Aortic Intramural Hemorrhage Compared With Acute Aortic Dissection

Cited by 65 publications

References 14 publications

Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma

Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma

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

Long-Term Follow-Up of Aortic Intramural Hematoma

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