Clinical Comparison of Aortic Intramural Hemorrhage with Aortic Dissection Involving the Ascending Aorta

ABSTRACT

BACKGROUND AND OBJECTIVES: Although aortic intramural hemorrhage (AIH) is different from classic aortic dissection (AD) in terms of absence of continuous direct flow communication through intimal tear, the same treatment strategy, emergent surgical repair, has been applied for patients with AIH involving the ascending aorta. The impact of different false lumen hemodynamic has not been seriously investigated and clinical features of AIH and AD have not been directly compared. METHODS: From 1990 to December 1998, clinical evaluation with various imaging modalities confirmed the diagnosis of proximal AD and AIH in 73 and 18 patients, respectively. Direct comparison of clinical data including clinical features, hospital course, and follow-up data was performed retrospectively. RESULTS: Patients with AIH were older (69+/-10 years-old 49+/-14, p0.05). CONCLUSIONS: Patients with proximal AIH shows different clinical features and much better prognosis with medical treatment compared to those with AD. These results support our initial hypothesis that AIH is not just a precursor of overt AD but a distinct disease entity and absence of continuous flow communication in AIH can have different clinical impact. This should encourage systematic investigations to find out the predictors of development of complications and to assess the role of elective surgery with frequent imaging follow-up in proximal AIH.