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(Circulation. 2003;108:583.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Long-Term Follow-Up of Aortic Intramural Hematoma

Predictors of Outcome

Arturo Evangelista, MD, FESC; Rosa Dominguez, MD; Carmen Sebastia, MD; Armando Salas, MD; Gaieta Permanyer-Miralda, MD; Gustavo Avegliano, MD; Cristina Elorz, MD; Teresa Gonzalez-Alujas, MD; Herminio Garcia Del Castillo, MD; Jordi Soler-Soler, MD, FESC

From Servei de Cardiología and Institut de Diagnòstic per la Imatge (R.D., C.S.), Hospital General Universitari Vall d’Hebron, Barcelona, Spain.

Correspondence to Arturo Evangelista, Servei de Cardiología, Hospital General Universitari Vall d’Hebron, Passeig Vall d’Hebron 119-129, 08035, Spain. E-mail evangel{at}hg.vhebron.es

Received December 16, 2002; de novo received March 4, 2003; revision received May 13, 2003; accepted May 14, 2003.

Background— Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH.

Methods and Results— Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45±31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (P<0.02) and to longitudinal extension of IMH (P<0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH.

Conclusions— The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.

Key Words: aorta • follow-up studies • imaging • magnetic resonance imaging • echocardiography

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