Acute Intramural Hematoma of the Aorta

作者：Arturo Evangelista, Debabrata Mukherjee, Rajendra H. Mehta, Patrick T. O’Gara, Rossella Fattori, Jeanna V. Cooper, Dean E. Smith, Jae K. Oh, Stuart James Hutchison, Udo P Sechtem, Eric M. Isselbacher, Christoph Anton Nienaber, Linda A. Pape, Kim Allen Eagle · 发表于：Circulation · 年份：2005 · DOI：10.1161/01.cir.0000156444.26393.80 · 被引用次数：499 · 研究领域：Aortic Disease and Treatment Approaches、Cardiac Structural Anomalies and Repair、Congenital Heart Disease Studies

BACKGROUND: The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. METHODS AND RESULTS: We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; P<0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; P<0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; P=0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; P=0.60) and the ascending aorta (39.1% versus 29.9%; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study. CONCLUSIONS: The IRAD data demonstrate a 5.7% prevalence of IMH in patients ...