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(Circulation. 2003;108:II-307.)
© 2003 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

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

Shuichiro Kaji, MD; Takashi Akasaka, MD; Minako Katayama, MD; Atsushi Yamamuro, MD; Kenji Yamabe, MD; Koichi Tamita, MD; Maki Akiyama, MD; Nozomi Watanabe, MD; Kazuo Tanemoto, MD; Shigefumi Morioka, MD; Kiyoshi Yoshida, MD

From the Division of Cardiovascular Medicine and Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan; Division of Cardiology, Kobe General Hospital, Kobe, Japan.

Correspondence to Shuichiro Kaji, MD, Division of Cardiology, Kobe General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe, Japan 650-0046. Phone: 81-78-302-4321; Fax: 81-78-302-7537; E-mail: skaji{at}kcgh.gr.jp

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%, P=0.006). Mean follow-up periods were 53±43 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%) (P=0.009). Multivariate analysis identified age >70 years and new appearance of an ulcerlike projection as the strongest predictors of progression in patients with IMH.

Conclusions— Patients with type B IMH have better long-term prognosis than patients with AD. Older age and appearance of an ulcerlike projection are predictive for progression in patients with type B IMH.

Key Words: aorta • follow-up studies • mortality • prognosis • survival