Surgical versus conservative treatment for acute type A aortic intramural hematoma: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH). Methods    Clinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group). Results    Finally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P>0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P<0.001). Conclusion    The mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.

Surgical treatment of Stanford A intramural hematoma / 中华胸心血管外科杂志

Objective@#To summarize experience and result in surgical treatment of Stanford type A intramural hematoma.@*Methods@#60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement.@*Results@#In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%.@*Conclusion@#Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.

Surgical treatment of Stanford A intramural hematoma / 中华胸心血管外科杂志

Objective To summarize experience and result in surgical treatment of Stanford type A intramural hematoma.Methods 60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017.Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta,maximum aorta diameter≥50 mm,progressive maximum aortic wall thickness≥i0 mm,pericardial or pleural effusion,persistent or recurrent pain.Aortic valve regurgitation.In our group,46 patients recieved ascending aorta replacement + Sun's procedure.6 patients recieved Bentall + Sun's procedure.4 patients recieved asceding aorta + hemiarch replacement.2 patients recieved Bentall + hemiarch replacement.2 patients recieved asceding aorta replacement.Results In the whole group,there was 1 (1.7％) operative death because of multiple organ failure after operation.Hyoxemiaoccured in 5(8.3％) patients,2(3.3％) patients occurred new renal failure and required CRRT treatment,cerebrovascular complication occurred in 1 (1.7％)patient,re-sternotomy due to bleeeding occured in 1 (1.7％) patient and paraplegia occured in 1 (1.7％) patient after operation.but they recoved quickly after proper treatment.During follow up period,there were 4 cases need reintervention,including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year.Two other reinterventions were performed for endoleak by interventional occlusion.During the follow-up,hematoma absorption rates after treatment 1、3 and 6 months were 68.6％,84.7％ and 94.8％.Conclusion Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.

Analysis of Factors That Affect Plasma D-Dimmer Level in Acute Aortic Syndrome / 天津医药

Objective To explore the factors that could affect plasma level of D-dimmer test in acute aortic syn-drome. Methods Blood samples (2 mL) from acute aortic syndrome patients (n=76) obtained immediately after admission to detect D-dimmer using ELISA. Blood routine test and biochemical indicators tests including creatinine were also performed. White blood cell (WBC), serum value of creatinine, aortic contrast-enhanced CT, incidence of Shock and death were all re-corded. The receiver-operating characteristic curve (ROC) was established to assess the potency of D-dimmer to predict hospital mortality. Results According to ROC analysis, the optimal cut-off value of D-dimmer to predict hospital mortality was >2 988.6 μg/L (FEU), with 86.7% sensitivity and 70.5% specificity. The patients were divided into group A (D-dim-mer<2 988.6μg/L FEU, n=45) and group B (D-dimmer≥2 988.6μg/L FEU,n=31). Onset timing was longer in group A than that in group B(P<0.01). Involvement of ascending aorta was less common in group A than in group B(P<0.05). Aortic intramural hematoma was less common in group A than in group B(P<0.05). Logistic analysis demonstrated that short time of onset, involvement of ascending aorta, non-aortic intramural hematoma were all independent factors of higher D-dimmer (≥2 988.6μg/L FEU). Conclusion Patients with long time of onset, without involvement of ascending aorta, with intramural hematoma are liable to have lower values of plasma D-dimmer.

Aortic intramural hematoma after thrombolysis in a patient with acute massive pulmonary embolism

No abstract available.

Ruptura dos vasa vasorum e hematoma intramural da aorta: um paradigma em mudança / Rupture of vasa vasorum and intramural hematoma of the aorta: a changing paradigm

A ruptura dos vasa vasorum tem sido reconhecida como uma das causas do hematoma intramural da aorta há 90 anos. Esta breve revisão apresenta sistematicamente a fisiologia desses vasos e o seu papel na fisiopatologia das alterações parietais da aorta que ocorrem na hipertensão arterial, na arteriosclerose e na síndrome aórtica aguda. A hipótese defendida aqui é a de que a ruptura dos vasa vasorum ocorre como um fenômeno secundário e não como um dos fatores causais na fisiopatologia do hematoma intramural.

Rupture of vasa varorum has been recognized as one cause of intramural hematoma of the aorta for 90 years. This brief revision presents systematically, the physiology of these vessels and its role in the physiopathology of the alterations in the aortic wall secondary to hypertension, arteriosclerosis and in Acute Aortic Syndrome. The hypothesis is that rupture of vasa vasorum is a secondary phenomenon and not one causal factor in the physiopathology of intramural hematoma.

Update on Acute Aortic Syndrome

For the last decade, we have witnessed dramatic changes in both diagnostic and therapeutic aspects of acute aortic syndrome (AAS). With recent advances of various noninvasive aortic pathology imaging modalities, aortic intramural hematoma (AIH), a variant form of classic aortic dissection (AD), has emerged as an increasingly recognized and potentially fatal AAS entity. As the natural course of AD and AIH, especially with medical treatment, has been reported quite different, there has been a suggestion of applying different treatment strategies based not only on the affected sites of the aorta but also the different AAS entities, which is still in debate. Endovascular stent-graft placement is a revolutionary change in the treatment of various aortic pathologies including AAS. In the next decade, dramatic changes in clinical practice and outcome for patients with AAS are expected using new diagnostic information to select the best treatment option for individual patients.

Aortic Intramural Hematoma Diagnosed in the Emergency Department

PURPOSE: An aortic intramural hematoma (AIH) is a medical disease known to be a variant form of an aortic dissection without intimal tearing. Although it is not often encountered in the emergency department (ED), emergency physicians have to differentiate it from other aortic diseases or ischemic heart disease because the disease processes are similar and/or the symptoms, such as sudden chest pain, are the same. For that reason, we evaluated the clinical and radiological characteristics of AIH, as well as its treatment plans, complications, and follow-up results. METHODS: From 1995 to September 2002, a total of 30 patients were diagnosed with AIH by using computerized tomography (CT) in the Emergency Department, Yeungnam University Hospital. We reviewed the clinical charts and X-ray films retrospectively and evaluated the clinical features, the hospital courses, and the follow-up results. Also, we divided the patients into two groups according to the involvement of AIH : Stanford type A involved the ascending aorta and the aortic arch and accounted for 10 cases, whereas type B involved only the descending aorta and accounted for 20 cases. The data for the two groups were then compared. RESULTS: Of the 30 patients, the number of type B was twice that of type A. Of the 16 males in the study, 14 (88%) were type B. Almost all patients omplained of chest pain, back pain, or both, 80% had hypertension and 50% were smokers. Of the type A patients, 70% showed mediastinal widening on chest X-ray, which was confirmed by CT. According to the type of aortic wall thickness on CT, 50% were circular and 50% were crescentic. Complications included in 5 cases of pericardial effusion, of which 1 patient had a pericardial tamponade. Each 1 of these 5 patients progressed to aortic dissection and aortic rupture, after which they died. All patients except one took medical therapy, 2/3 of whom were followed up within at least one year. CONCLUSION: AIH is not a very common disease, but is often encountered in the ED. It 's a medical, not a surgical disease, but requires surgical therapy in cases of ascending aortic dissection or cardiac tamponade, and aortic rupture. Almost all patients with AIH can be diagnosed by emergency physicians using computerized tomography in the ED, so we think that it is very important to assess the patient's clinical status and complications, to monitor the patient carefully in the ED, and to make plans for follow-up.

Two Cases of Aortic Intramural Hematoma Diagnosed with Transesophageal Echocardiography

Aortic intramural hematoma(AIH) is known as a variant of acute dissection due to rupture of the vasa vasorum without a intimal tear. In elderly hypertension patients patients with aortic dissection but without the characteristic echocardiographic findings of a double-channel aorta, this disease entity should be suspected and attention should be given to find segmental wall thickening of the aorta >0.7cm. AIH may progress to typical dissection or to rupture in considerable number of the patients, so careful follow-up is necessary and the same management principles for the patients with dissection can be applied in this variant. We report two cases of AIH showing typical eccentric mural thickening without dissection membrane with transesophageal echocardiographic follow-up.