(Circulation. 1995;92:1465-1472.)
© 1995 American Heart Association, Inc.
Articles |
Intramural Hemorrhage of the Thoracic Aorta
Diagnostic and Therapeutic Implications
From the Department of Internal Medicine, Division of Cardiology, and Departments of Diagnostic Radiology (R.P.S.) and Human Pathology (U.H.), University Hospital Eppendorf, Hamburg, and the Department of Cardiovascular Surgery (R.L., A.H.), Christian-Albrechts-University, Kiel, Germany.
Correspondence to Christoph A. Nienaber, MD, Department of Internal Medicine, Division of Cardiology, University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany.
Background Intramural hemorrhage (IMH) was recently identified at necropsy and anecdotally in vivo as a unique aortic syndrome (without entry and with no flap-like intraluminal component, such as overt aortic dissection). However, little is known about diagnosis, prognosis, and outcome of IMH.
Methods and Results Between 1983 and 1993, 360 patients from two medical centers with clinical indications of aortic dissection were prospectively evaluated; they presented to the emergency department a median of 3.5 hours after onset of back or chest pain or other suggestive symptoms. Among 195 patients with aortic syndromes, 25 patients (12.8%) were diagnosed to have IMH of the thoracic aorta with no evidence of a primary intimal tear, flap, or overt dissection by multiple noninvasive imaging modalities, including magnetic resonance imaging (n=12), contrast-enhanced computed tomography (n=14), and transesophageal echocardiography (n=3) in random order. There were 16 men and 9 women with a median age of 56±13 years (range, 15 to 80 years). Arterial hypertension was present in the majority (84%), and Marfan's syndrome was present in 3 patients (12%). IMH was diagnosed within 4 days of hospital admission (median, 2.5 hours). IMH involved the ascending aorta (type A) in 12 cases (48%), the aortic arch in 2 (8%), and the descending aorta (type B) in 11 cases (44%); imaging results were validated by crossmatching with intraoperative, pathomorphological, and/or angiographic findings. IMH was 8.5±5 cm in length and 2.0±1.2 cm in aortic wall thickness. Aortic regurgitation and pericardial and mediastinal effusion were present in 5 of 12 patients (42%) with type A IMH and 2 of 11 patients (18%) with type B IMH. IMH progression to overt dissection, rupture, and/or acute tamponade occurred in 8 of 25 patients (32%) within 24 to 72 hours, indicating the need for urgent intervention. The 30-day mortality rate of IMH afflicting the ascending aorta was 80% (4 of 5 cases) with medical treatment (sedation and blood pressure control) versus no mortality in 7 cases with early surgical repair (P<.01); after 1 year, 71.4% of surgically treated patients were alive versus 20% in the medical group (P<.05). IMH of the aortic arch resulted in an early mortality of 50% (1 of 2 patients) with medical treatment. In IMH confined to the descending thoracic aorta, survival with medical treatment was not different from surgical therapy; there was 1 early death among 6 patients with medical therapy and none out of 5 patients with surgery (P=NS). At 1-year follow-up, medical and surgical therapy groups had survival rates of 80% and 83%, respectively (P=NS).
Conclusions IMH is associated with a clinical profile and prognosis similar to classic dissection and may be considered an ominous precursor of overt aortic dissection. Tomographic noninvasive imaging ensures rapid, nontraumatic diagnosis of IMH. The outcome of IMH of the ascending aorta appears favorable only with immediate surgical repair.
Key Words: aorta • imaging • prognosis • magnetic resonance imaging • tomography
This article has been cited by other articles:
 |
|
 |
|
  J.-K. Song, J. H. Yim, J.-M. Ahn, D.-H. Kim, J.-W. Kang, T. Y. Lee, J.-M. Song, S. J. Choo, D.-H. Kang, C. H. Chung, et al. Outcomes of Patients With Acute Type A Aortic Intramural Hematoma Circulation, November 24, 2009; 120(21): 2046 - 2052. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 M. M. Elahi, M. Jafari Giv, M. Krishnaswamy, C. McLachlan, P. J. Mossop, and I. K. Nixon Ascending aortic arch replacement with aortic valve resuspension under deep hypothermic arrest combined with endoluminal stenting of the descending thoracic aorta and the entire abdominal aorta J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 1032 - 1035. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Litmanovich, A. A. Bankier, L. Cantin, V. Raptopoulos, and P. M. Boiselle CT and MRI in Diseases of the Aorta Am. J. Roentgenol., October 1, 2009; 193(4): 928 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Estrera, C. Miller III, T.-Y. Lee, P. De Rango, S. Abdullah, J.-C. Walkes, D. Milewicz, and H. Safi Acute Type A Intramural Hematoma: Analysis of Current Management Strategy Circulation, September 15, 2009; 120(11_suppl_1): S287 - S291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kitai, S. Kaji, A. Yamamuro, T. Tani, K. Tamita, M. Kinoshita, N. Ehara, A. Kobori, M. Nasu, Y. Okada, et al. Clinical Outcomes of Medical Therapy and Timely Operation in Initially Diagnosed Type A Aortic Intramural Hematoma: A 20-Year Experience Circulation, September 15, 2009; 120(11_suppl_1): S292 - S298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Vilacosta, P Aragoncillo, V Canadas, J A San Roman, J Ferreiros, and E Rodriguez Acute aortic syndrome: a new look at an old conundrum Heart, July 15, 2009; 95(14): 1130 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H A Vargas, E T D Hoey, D Gopalan, S K B Agrawal, N J Screaton, and G S Gulati Congenital and acquired conditions of the aortic root: multidetector computed tomography features Postgrad. Med. J., July 1, 2009; 85(1005): 383 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. P. Chao, T. G. Walker, and S. P. Kalva Natural History and CT Appearances of Aortic Intramural Hematoma1 RadioGraphics, May 1, 2009; 29(3): 791 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Patel and R. R. Arora Pathophysiology, diagnosis, and management of aortic dissection Therapeutic Advances in Cardiovascular Disease, December 1, 2008; 2(6): 439 - 468. [Abstract] [PDF]
|
|
|
|
|
|
A. F Bolger Aortic intramural haematoma Heart, December 1, 2008; 94(12): 1670 - 1674. [Full Text] [PDF]
|
|
|
|
 |
|
 K.-H. Park, C. Lim, J. H. Choi, K. Sung, K. Kim, Y. T. Lee, and P. W. Park Prevalence of Aortic Intimal Defect in Surgically Treated Acute Type A Intramural Hematoma Ann. Thorac. Surg., November 1, 2008; 86(5): 1494 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-B. Kan, R.-Y. Chang, and J.-P. Chang Optimal initial treatment and clinical outcome of type A aortic intramural hematoma: a clinical review Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1002 - 1006. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Shimokawa, N. Ozawa, S. Takanashi, and T. Itoh Intermediate-Term Results of Surgical Treatment of Acute Intramural Hematoma Involving the Ascending Aorta Ann. Thorac. Surg., March 1, 2008; 85(3): 982 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
 |
|
 N. H. Krarup, S. H. Poulsen, U. Baandrup, K.-E. Klaaborg, and H. Egeblad Aorto-mitral inflammation in rheumatological disease: Transoesophageal echocardiographic presentation Eur J Echocardiogr, October 1, 2007; 8(5): 346 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M R Jones and J H Reid Emergency chest radiology: thoracic aortic disease and pulmonary embolism Imaging, September 1, 2006; 18(3): 122 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Makita, A. Ohira, Y. Naganuma, Y. Moriai, H. Niinuma, A. Abiko, and K. Hiramori Increased Carotid Artery Stiffness Without Atherosclerotic Change in Patients With Aortic Dissection Angiology, August 1, 2006; 57(4): 478 - 486. [Abstract] [PDF]
|
|
|
|
|
|
S. Trimarchi, C. A. Nienaber, V. Rampoldi, T. Myrmel, T. Suzuki, E. Bossone, V. Tolva, M. G. Deeb, G. R. Upchurch Jr, J. V. Cooper, et al. Role and Results of Surgery in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD) Circulation, July 4, 2006; 114(1_suppl): I-357 - I-364. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bitar, A. R. Moody, G. Leung, A. Kiss, D. Gladstone, D. J. Sahlas, and R. Maggisano In vivo identification of complicated upper thoracic aorta and arch vessel plaque by MR direct thrombus imaging in patients investigated for cerebrovascular disease. Am. J. Roentgenol., July 1, 2006; 187(1): 228 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sueyoshi, I. Sakamoto, M. Uetani, and Y. Matsuoka CT Analysis of the Growth Rate of Aortic Diameter Affected by Acute Type B Intramural Hematoma Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S414 - S420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Ahmad, N Cheshire, and M Hamady Acute aortic syndrome: pathology and therapeutic strategies. Postgrad. Med. J., May 1, 2006; 82(967): 305 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Flachskampf Assessment of Aortic Dissection and Hematoma Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 83 - 88. [Abstract] [PDF]
|
|
|
|
 |
|
 R. G. Hayter, J. T. Rhea, A. Small, F. S. Tafazoli, and R. A. Novelline Suspected Aortic Dissection and Other Aortic Disorders: Multi-Detector Row CT in 373 Cases in the Emergency Setting Radiology, March 1, 2006; 238(3): 841 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. T. Tsai, C. A. Nienaber, and K. A. Eagle Acute Aortic Syndromes Circulation, December 13, 2005; 112(24): 3802 - 3813. [Full Text] [PDF]
|
|
|
|
|
|
G. Garzon, M. Fernandez-Velilla, M. Marti, I. Acitores, F. Ybanez, and L. Riera Endovascular Stent-Graft Treatment of Thoracic Aortic Disease RadioGraphics, October 1, 2005; 25(suppl_1): S229 - S244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Uchida, K. Imoto, M. Takahashi, S.-i. Suzuki, S. Isoda, M. Sugiyama, J. Kondo, and Y. Takanashi Pathologic Characteristics and Surgical Indications of Superacute Type A Intramural Hematoma Ann. Thorac. Surg., May 1, 2005; 79(5): 1518 - 1521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Evangelista, D. Mukherjee, R. H. Mehta, P. T. O'Gara, R. Fattori, J. V. Cooper, D. E. Smith, J. K. Oh, S. Hutchison, U. Sechtem, et al. Acute Intramural Hematoma of the Aorta: A Mystery in Evolution Circulation, March 1, 2005; 111(8): 1063 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sueyoshi, I. Sakamoto, M. Fukuda, K. Hayashi, and T. Imada Long-Term Outcome of Type B Aortic Intramural Hematoma: Comparison With Classic Aortic Dissection Treated by the Same Therapeutic Strategy Ann. Thorac. Surg., December 1, 2004; 78(6): 2112 - 2117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Srichai, M. L. Lieber, B. W. Lytle, J. M. Kasper, and R. D. White Acute dissection of the descending aorta: noncommunicating versus communicating forms Ann. Thorac. Surg., June 1, 2004; 77(6): 2012 - 2020. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. T. O'Gara, A. J. Greenfield, N. A. Afridi, and S. L. Houser Case 12-2004 - A 38-Year-Old Woman with Acute Onset of Pain in the Chest N. Engl. J. Med., April 15, 2004; 350(16): 1666 - 1674. [Full Text] [PDF]
|
|
|
|
|
|
C A Nienaber, B M Richartz, T Rehders, H Ince, and M Petzsch Aortic intramural haematoma: natural history and predictive factors for complications Heart, April 1, 2004; 90(4): 372 - 374. [Full Text] [PDF]
|
|
|
|
|
|
M D Dake Aortic intramural haematoma: current therapeutic strategy Heart, April 1, 2004; 90(4): 375 - 378. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Evangelista, R. Dominguez, C. Sebastia, A. Salas, G. Permanyer-Miralda, G. Avegliano, Z. Gomez-Bosh, T. Gonzalez-Alujas, H. Garcia del Castillo, and J. Soler-Soler Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma: Therapeutic implications Eur. Heart J., January 1, 2004; 25(1): 81 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Demers, D. C. Miller, R. S. Mitchell, S. T. Kee, L. Chagonjian, and M. D. Dake Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results Ann. Thorac. Surg., January 1, 2004; 77(1): 81 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Tatli, M. J. Lipton, B. D. Davison, R. B. Skorstad, and E. K. Yucel From the RSNA Refresher Courses: MR Imaging of Aortic and Peripheral Vascular Disease RadioGraphics, October 1, 2003; 23(90001): S59 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Castaner, M. Andreu, X. Gallardo, J. M. Mata, M. A. Cabezuelo, and Y. Pallardo CT in Nontraumatic Acute Thoracic Aortic Disease: Typical and Atypical Features and Complications RadioGraphics, October 1, 2003; 23(90001): S93 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaji, T. Akasaka, M. Katayama, A. Yamamuro, K. Yamabe, K. Tamita, M. Akiyama, N. Watanabe, K. Tanemoto, S. Morioka, et al. Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma Circulation, September 9, 2003; 108(90101): II-307 - 311. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Suzuki, R. H. Mehta, H. Ince, R. Nagai, Y. Sakomura, F. Weber, T. Sumiyoshi, E. Bossone, S. Trimarchi, J. V. Cooper, et al. Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD) Circulation, September 9, 2003; 108(90101): II-312 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-M. Song, H.-S. Kim, J.-K. Song, D.-H. Kang, M.-K. Hong, J.-J. Kim, S.-W. Park, S.-J. Park, T.-H. Lim, and M.-G. Song Usefulness of the Initial Noninvasive Imaging Study to Predict the Adverse Outcomes in the Medical Treatment of Acute Type A Aortic Intramural Hematoma Circulation, September 9, 2003; 108(90101): II-324 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Nienaber and K. A. Eagle Aortic Dissection: New Frontiers in Diagnosis and Management: Part I: From Etiology to Diagnostic Strategies Circulation, August 5, 2003; 108(5): 628 - 635. [Full Text] [PDF]
|
|
|
|
|
|
A. Evangelista, R. Dominguez, C. Sebastia, A. Salas, G. Permanyer-Miralda, G. Avegliano, C. Elorz, T. Gonzalez-Alujas, H. Garcia Del Castillo, and J. Soler-Soler Long-Term Follow-Up of Aortic Intramural Hematoma: Predictors of Outcome Circulation, August 5, 2003; 108(5): 583 - 589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Motoyoshi, Y. Moizumi, T. Komatsu, and K. Tabayashi Intramural hematoma and dissection involving ascending aorta: the clinical features and prognosis Eur. J. Cardiothorac. Surg., August 1, 2003; 24(2): 237 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Yoshida, H. Akiba, M. Tamakawa, N. Yama, M. Hareyama, K. Morishita, and T. Abe Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy--Comparison of Emergency Helical CT and Surgical Findings Radiology, August 1, 2003; 228(2): 430 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. von Kodolitsch, S. K. Csosz, D. H. Koschyk, I. Schalwat, R. Loose, M. Karck, C. Dieckmann, R. Fattori, A. Haverich, J. Berger, et al. Intramural Hematoma of the Aorta: Predictors of Progression to Dissection and Rupture Circulation, March 4, 2003; 107(8): 1158 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Moffatt and R. S. Mitchell Endovascular Stent Management of Thoracic Aneurysms and Dissections Card. Surg. Adult, January 1, 2003; 2(2003): 1191 - 1204. [Full Text]
|
|
|
|
|
|
Y. Moizumi, T. Komatsu, N. Motoyoshi, and K. Tabayashi Management of patients with intramural hematoma involving the ascending aorta J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 918 - 924. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaji, T. Akasaka, Y. Horibata, K. Nishigami, H. Shono, M. Katayama, A. Yamamuro, S. Morioka, I. Morita, K. Tanemoto, et al. Long-Term Prognosis of Patients With Type A Aortic Intramural Hematoma Circulation, September 24, 2002; 106(12_suppl_1): I-248 - I-252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sueyoshi, Y. Matsuoka, T. Imada, T. Okimoto, I. Sakamoto, and K. Hayashi New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation Radiology, August 1, 2002; 224(2): 536 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Nienaber and H.-H. Sievers Intramural Hematoma in Acute Aortic Syndrome: More Than One Variant of Dissection? Circulation, July 16, 2002; 106(3): 284 - 285. [Full Text] [PDF]
|
|
|
|
|
|
F. Ganaha, D. C. Miller, K. Sugimoto, Y. S. Do, H. Minamiguchi, H. Saito, R. S. Mitchell, and M. D. Dake Prognosis of Aortic Intramural Hematoma With and Without Penetrating Atherosclerotic Ulcer: A Clinical and Radiological Analysis Circulation, July 16, 2002; 106(3): 342 - 348. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Khan and C. K. Nair Clinical, Diagnostic, and Management Perspectives of Aortic Dissection* Chest, July 1, 2002; 122(1): 311 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Mehta, T. Suzuki, P. G. Hagan, E. Bossone, D. Gilon, A. Llovet, L. C. Maroto, J. V. Cooper, D. E. Smith, W. F. Armstrong, et al. Predicting Death in Patients With Acute Type A Aortic Dissection Circulation, January 15, 2002; 105(2): 200 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Erbel, F. Alfonso, C. Boileau, O. Dirsch, B. Eber, A. Haverich, H. Rakowski, J. Struyven, K. Radegran, U. Sechtem, et al. Diagnosis and management of aortic dissection: Task Force on Aortic Dissection, European Society of Cardiology Eur. Heart J., September 2, 2001; 22(18): 1642 - 1681. [PDF]
|
|
|
|
 |
|
 J.-K. Song, H.-S. Kim, D.-H. Kang, T.-H. Lim, M.-G. Song, S.-W. Park, and S.-J. Park Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1604 - 1610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mohr-Kahaly Aortic intramural hematoma: from observation to therapeutic strategies J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1611 - 1613. [Full Text] [PDF]
|
|
|
|
|
|
M. Groenink, A. de Roos, B. J. M. Mulder, B. Verbeeten Jr, J. Timmermans, A. H. Zwinderman, J. A. E. Spaan, and E. E. van der Wall Biophysical Properties of the Normal-sized Aorta in Patients with Marfan Syndrome: Evaluation with MR Flow Mapping Radiology, May 1, 2001; 219(2): 535 - 540. [Abstract] [Full Text]
|
|
|
|
|
|
I. VILACOSTA and J. A. S. ROMÁN Acute aortic syndrome Heart, April 1, 2001; 85(4): 365 - 368. [Full Text]
|
|
|
|
|
|
G. Vaccari, S. Caciolli, G. Calamai, M. Acquafresca, G. Montesi, L. Braconi, M. Cassai, and A. M. Perna Intramural hematoma of the aorta: diagnosis and treatment Eur. J. Cardiothorac. Surg., February 1, 2001; 19(2): 170 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Yoshino, E. Kachi, S. Matsue, M. Yotsukura, and K. Ishikawa Transition from Classic Aortic Dissection to Aortic Intramural Hemorrhage: A Case Report Angiology, November 1, 2000; 51(11): 971 - 975. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. von Kodolitsch, A. G. Schwartz, and C. A. Nienaber Clinical Prediction of Acute Aortic Dissection Arch Intern Med, October 23, 2000; 160(19): 2977 - 2982. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Hagan, C. A. Nienaber, E. M. Isselbacher, D. Bruckman, D. J. Karavite, P. L. Russman, A. Evangelista, R. Fattori, T. Suzuki, J. K. Oh, et al. The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease JAMA, February 16, 2000; 283(7): 897 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaji, K. Nishigami, T. Akasaka, T. Hozumi, T. Takagi, T. Kawamoto, H. Okura, H. Shono, Y. Horibata, T. Honda, et al. Prediction of Progression or Regression of Type A Aortic Intramural Hematoma by Computed Tomography Circulation, November 9, 1999; 100 (2009): II-281 - II-286. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Kim, K. A. Eagle, and E. M. Isselbacher Bayesian Persuasion Circulation, October 19, 1999; 100 (16): e68 - e72. [Full Text] [PDF]
|
|
|
|
|
|
M. Porcellini, S. Elia, L. Camera, and G. Bracale Intramural hematoma of the thoracic aorta in octogenarians: is non operation justified? Eur. J. Cardiothorac. Surg., October 1, 1999; 16(4): 414 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson, S. B. Labib, A. C. Eisenhauer, and J. R. Butterly Intimal Tear Without Hematoma : An Important Variant of Aortic Dissection That Can Elude Current Imaging Techniques Circulation, March 16, 1999; 99(10): 1331 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Sebastia, E. Pallisa, S. Quiroga, A. Alvarez-Castells, R. Dominguez, and A. Evangelista Aortic Dissection: Diagnosis and Follow-up with Helical CT RadioGraphics, January 1, 1999; 19(1): 45 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Vilacosta, J. A. San Roman, P. Aragoncillo, J. Ferreiros, R. Mendez, C. Graupner, E. Batlle, J. Serrano, A. Pinto, and J. M. Oyonarte Penetrating atherosclerotic aortic ulcer: documentation by transesophageal echocardiography J. Am. Coll. Cardiol., July 1, 1998; 32(1): 83 - 89. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Moriyama, G. Yotsumoto, K. Kuriwaki, S. Watanabe, K. Hisatomi, S. Shimokawa, H. Toyohira, and A. Taira Intramural hematoma of the thoracic aorta Eur. J. Cardiothorac. Surg., March 1, 1998; 13(3): 230 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M A DE BELDER Ultrasonic imaging of aortic atheroma Heart, February 1, 1998; 79(2): 111 - 112. [Full Text]
|
|
|
|
|
|
A. P. Banning, K. M. Harris, A. C. Braverman, and M. Rosenbloom Aortic Intramural Hematoma N. Engl. J. Med., November 13, 1997; 337(20): 1476 - 1477. [Full Text]
|
|
|
|
|
|
K. M. Harris, A. C. Braverman, F. R. Gutierrez, B. Barzilai, and V. G. Davila-Roman TRANSESOPHAGEAL ECHOCARDIOGRAPHIC AND CLINICAL FEATURES OF AORTIC INTRAMURAL HEMATOMA J. Thorac. Cardiovasc. Surg., October 1, 1997; 114(4): 619 - 626. [Abstract] [Full Text]
|
|
|
|
|
|
T. Laperche, C. Laurian, R. Roudaut, P. G. Steg, and f. t. F. E. d. l. S. F. de Cardiologie Mobile Thromboses of the Aortic Arch Without Aortic Debris : A Transesophageal Echocardiographic Finding Associated With Unexplained Arterial Embolism Circulation, July 1, 1997; 96(1): 288 - 294. [Abstract] [Full Text]
|
|
|
|
|
|
N. T. Kouchoukos and D. Dougenis Surgery of the Thoracic Aorta N. Engl. J. Med., June 26, 1997; 336(26): 1876 - 1889. [Full Text] [PDF]
|
|
|
|
|
|
R. Fattori, F. Celletti, P. Bertaccini, R. Galli, D. Pacini, A. Pierangeli, and G. Gavelli Delayed Surgery of Traumatic Aortic Rupture: Role of Magnetic Resonance Imaging Circulation, December 1, 1996; 94(11): 2865 - 2870. [Abstract] [Full Text]
|
|
|
|
 |
|
 Aortic Hemorrhage and Dissection Are Clinically Similar Journal Watch Cardiology, November 1, 1995; 1995(1101): 15 - 15. [Full Text]
|
|
|
|
|
|
P. T. O'Gara and R. W. DeSanctis Acute Aortic Dissection and Its Variants : Toward a Common Diagnostic and Therapeutic Approach Circulation, September 15, 1995; 92(6): 1376 - 1378. [Full Text]
|
|