This Article Full Text Full Text (PDF) All Versions of this Article: 120/21/2046    most recent CIRCULATIONAHA.109.879783v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Song, J.-K. Articles by Lim, T.-H. PubMed PubMed Citation Articles by Song, J.-K. Articles by Lim, T.-H. Related Collections CV surgery: aortic and vascular disease Related Articles

(Circulation. 2009;120:2046-2052.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

Jae-Kwan Song, MD; Ji Hye Yim, MD; Jung-Min Ahn, MD; Dae-Hee Kim, MD; Joon-Won Kang, MD; Taek Yeon Lee, MD; Jong-Min Song, MD; Suk Jung Choo, MD; Duk-Hyun Kang, MD; Cheol Hyun Chung, MD; Jae Won Lee, MD; Tae-Hwan Lim, MD

From the Divisions of Cardiology (Jae-Kwan Song, J.H.Y., J.A., D.H.K., Jong-Min Song, D.K.), Radiology (J.K., T.L.), and Thoracic Surgery (T.Y.L., S.J.C., C.H.C., J.W.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Correspondence to Jae-Kwan Song, MD, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-gu, Seoul, 138-736 South Korea. E-mail jksong{at}amc.seoul.kr

Received May 12, 2009; accepted September 9, 2009.

Background— The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications.

Methods and Results— Among 357 consecutive patients with type A acute aortic syndrome, 101 (28.3%) had IMH and 256 had AD. Urgent operations were performed in 224 patients with AD (87.5%) and 16 with unstable IMH (15.8%; P<0.001). The remaining 85 stable IMH patients received initial medical treatment, and adverse clinical events developed in 31 patients (36.5%) within 6 months, which included development of AD (n=25), delayed surgery (n=25), or death (n=6). Initial aorta diameter and hematoma thickness were independent predictors for development of these events, and the best cutoff values were 55 and 16 mm, respectively. The overall hospital mortality was lower in IMH patients than in AD patients (7.9% [8/101] versus 17.2% [44/256]; P=0.0296) and was comparable to that of surgically treated AD patients (7.9% versus 10.7% [24/224]; P=0.56). The 1-, 2-, and 3-year survival rates of IMH patients were 87.6±3.6%, 84.9±3.7%, and 83.1±4.1%, respectively. There was no statistical difference of overall survival rates between patients with IMH and surgically treated AD patients (P=0.787).

Conclusions— The clinical outcome of IMH patients receiving treatment by our policy was comparable to that of surgically treated AD patients. However, adverse clinical events were not uncommon with medical treatment alone, and initial aorta diameter and hematoma thickness may identify patients who might benefit from urgent surgery.

---

 

CLINICAL PERSPECTIVE

Related Articles:

Clinical Summaries
Circulation 2009 120: 2027-2028. [Extract] [Full Text]

Is the Optimal Management of Acute Type A Aortic Intramural Hematoma Evolving?

Artur Evangelista and Kim A. Eagle
Circulation 2009 120: 2029-2032. [Extract] [Full Text]

This article has been cited by other articles:

				A. Evangelista and K. A. Eagle Is the Optimal Management of Acute Type A Aortic Intramural Hematoma Evolving? Circulation, November 24, 2009; 120(21): 2029 - 2032. [Full Text] [PDF]