Meta-analysis of 143 reported cases of aortic intramural hematoma

Maraj, Rajiv; Rerkpattanapipat, Pairoj; Jacobs, Larry E.; Makornwattana, Porawat; Kotler, Morris N.

doi:10.1016/s0002-9149(00)01049-3

Cited by 192 publications

(122 citation statements)

References 25 publications

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“…Hence, it is generally considered a surgical emergency as if it was typical type A AD, with expeditious surgery indicated. In a meta-analysis 6 of series published up to 1999 which comprised of mostly Western patients, mortality of type A IMH treated medically was high. Subsequent studies 7 -8 involving white patients also showed frequent progression to serious complications and high mortality with medical treatment and favored early surgery as the treatment of choice in white patients.…”

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confidence: 99%

Type A Aortic Intramural Hematoma: Clinical Features and Outcomes in Chinese Patients

Cheung

Jim

et al. 2011

Clinical Cardiology

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Background: The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH). Methods and Results:We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of acute IMH by comparing these patients with those diagnosed with classical aortic dissection (AD). A total of 34 patients had IMH and they tended to be older (69.7±12.4 versus 60.5±16.2 years; p = 0.006). The development of pericardial effusion was more frequent in patients with IMH than in patients with AD. They were also less likely to receive surgery as compared to AD patients (26.5% versus 73.2%; p<0.0001). Overall mortality of IMH was not significantly higher than that of classic AD (29.4% versus 21.4%; p = 0.45). For IMH patients, the mortality rate with medical treatment was 32%. Ten (40%) of the 25 medically treated patients developed adverse outcomes. However, no independent predictors of adverse outcomes were identified in the study. In follow-up imaging studies of 15 patients who survived IMH without surgical repair, 14 patients showed complete resolution of IMH and 1 progressed into classical AD. Conclusion: Acute type A IMH in Chinese patients showed a high mortality rate with medical treatment. It has a highly unpredictable course with no reliable clinical and anatomical predictors. Surgical therapy should be the treatment of choice for Chinese patients with acute IMH, especially those who are younger and have less comorbidities.

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confidence: 99%

Type A Aortic Intramural Hematoma: Clinical Features and Outcomes in Chinese Patients

Cheung

Jim

et al. 2011

Clinical Cardiology

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“…In the largest analysis of 143 cases of IMH, 57% were reported to be type A, 5 although the vast majority (90%) of PAU is seen in the descending aorta. 1 There is controversy regarding the pathophysiology of IMH and PAU, and it has been suggested that IMH, PAU and AD are variations on a continuum of aortic disease.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic syndrome: a case presentation and review of the literature

Lissin

Vagelos

2002

Vasc Med

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Aortic disease can present as an acute chest pain syndrome. Although aortic dissection is the most common etiology, other processes such as intramural hematoma (IMH) and penetrating atherosclerotic ulcers are being increasingly recognized. They can all be accurately identi ed by computed tomography (CT) imaging or transesophageal echocardiography. The overlap between these processes regarding de nition and mechanism is controversial. Treatment for all three conditions has thus far been dictated by location, wherein ascending or arch involvement (Stanford type A) necessitates surgery and descending disease (type B) is treated medically. Small studies suggest that subgroups of type A IMH may be treated medically with good outcomes.Key words: acute aortic syndrome; aortic intramural hematoma; penetrating atherosclerotic ulcer Case presentationA 75-year-old woman presented with acute aortic syndrome.Twenty-four hours after arriving on a ight from London, England to San Francisco, California, our patient experienced the sudden onset of severe pleuritic chest and upper abdominal pain which radiated to her left arm and back. The pain was not affected by exertion, but decreased upon leaning forward. After 36 hours of pain, she developed severe dyspnea and presented to the emergency room. Nitroglycerin relieved her pain. She received one injection of low molecular weight heparin.The patient reported a recent low-grade temperature and non-productive cough. Her cardiovascular risk factors included hypertension and post-menopausal status. There was no history of diabetes mellitus, hypercholesterolemia, smoking, angina, myocardial infarction, congestive heart failure, deep venous thrombosis, anemia, hepatitis or tuberculosis. She had irritable bowel syndrome, managed with omeprazole, anti-spasmodics, and pancreatic enzyme supplements. Other medications were aspirin and nifedipine.On physical examination, the patient was a thin, anxious, Indian woman in moderate distress. The blood pressure was 116/75 mmHg in both upper extremities. The pulse was 98 and regular. The oxygen saturation level was 94% on 2 l of oxygen.Jugular venous pulsation was seen at 6 cm. There were no carotid bruits. The cardiac exam had a normal S1 and S2 without rubs, gallops, or murmurs. The lungs were clear bilaterally. The abdomen was soft and non-tender, without organomegaly, masses, or bruits. The extremities were normal with palpable pulses and without edema, tenderness, or cyanosis. Admission laboratory evaluation was signi cant for a CPK of 90 mg/dl with an MB relative index of 3.1 (normal ,3). The cardiac troponin T was slightly elevated at 0.07 ng/ml (normal ,0.01), WBC 13 000, Hct 33%, sodium 125 mmol/l, BUN 12 mg/dl (4.3 mmol/l), Cr 0.9 mg/dl (80 mmol/l), glucose 233 mg/dl (12.9 mmol/l), AST 146 IU/l, ALT 100 IU/l, total bilirubin 1.5 mg/dl (26 mmol/l) and alkaline phosphatase 74 IU/l. The initial electrocardiogram showed sinus rhythm with mild diffuse ST elevation and PR depression (Figure 1) and the chest X-ray revealed a tortuous ...

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“…IMH accounts for 10-25% of AAS [1,33,34]. Hypertension is the most common predisposing factor for IMH.…”

Section: Intramural Hematomamentioning

confidence: 99%

Acute Aortic Syndrome: Recent Trends in Imaging Assessment Using Computed Tomography Angiography

Kang

Lee

2017

Cardiovasc Imaging Asia

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Multidetector computed tomography (CT) has become the best modality for evaluating an aorta in the acute setting, due to its ability to rapidly detect aortic pathology with high spatial resolution. Moreover, using three-dimensional multiplanar reconstruction, CT scans can provide informative images and accurate measurements of aortic size and other anatomical landmarks. This review focuses on the CT imaging findings of aortic normal anatomy, aortic aneurysm, and the imaging spectrum of acute aortic syndrome, which includes penetrating atherosclerotic ulcer, intramural hematoma, and aortic dissection.

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Meta-analysis of 143 reported cases of aortic intramural hematoma

Cited by 192 publications

References 25 publications

Type A Aortic Intramural Hematoma: Clinical Features and Outcomes in Chinese Patients

Type A Aortic Intramural Hematoma: Clinical Features and Outcomes in Chinese Patients

Acute aortic syndrome: a case presentation and review of the literature

Acute Aortic Syndrome: Recent Trends in Imaging Assessment Using Computed Tomography Angiography

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