BACKGROUND: The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH). METHODS AND RESULTS: We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of acute IMH by comparing these patients with those diagnosed with classical aortic dissection (AD). A total of 34 patients had IMH and they tended to be older (69.7 ± 12.4 versus 60.5 ± 16.2 years; p=0.006). The development of pericardial effusion was more frequent in patients with IMH than in patients with AD. They were also less likely to receive surgery as compared to AD patients (26.5% versus 73.2%; p<0.0001). Overall mortality of IMH was not significantly higher than that of classic AD (29.4% versus 21.4%; p=0.45). For IMH patients, the mortality rate with medical treatment was 32%. Ten (40%) of the 25 medically treated patients developed adverse outcomes. However, no independent predictors of adverse outcomes were identified in the study. In follow-up imaging studies of 15 patients who survived IMH without surgical repair, 14 patients showed complete resolution of IMH and 1 progressed into classical AD. CONCLUSION: Acute type A IMH in Chinese patients showed a high mortality rate with medical treatment. It has a highly unpredictable course with no reliable clinical and anatomical predictors. Surgical therapy should be the treatment of choice for Chinese patients with acute IMH, especially those who are younger and have less comorbidities.
BACKGROUND: The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH). METHODS AND RESULTS: We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of acute IMH by comparing these patients with those diagnosed with classical aortic dissection (AD). A total of 34 patients had IMH and they tended to be older (69.7 ± 12.4 versus 60.5 ± 16.2 years; p=0.006). The development of pericardial effusion was more frequent in patients with IMH than in patients with AD. They were also less likely to receive surgery as compared to ADpatients (26.5% versus 73.2%; p<0.0001). Overall mortality of IMH was not significantly higher than that of classic AD (29.4% versus 21.4%; p=0.45). For IMHpatients, the mortality rate with medical treatment was 32%. Ten (40%) of the 25 medically treated patients developed adverse outcomes. However, no independent predictors of adverse outcomes were identified in the study. In follow-up imaging studies of 15 patients who survived IMH without surgical repair, 14 patients showed complete resolution of IMH and 1 progressed into classical AD. CONCLUSION: Acute type A IMH in Chinese patients showed a high mortality rate with medical treatment. It has a highly unpredictable course with no reliable clinical and anatomical predictors. Surgical therapy should be the treatment of choice for Chinese patients with acute IMH, especially those who are younger and have less comorbidities.
Authors: Camilo A Velasquez; Syed Usman Bin Mahmood; Mohammad A Zafar; Adam J Brownstein; Ayman Saeyeldin; Bulat A Ziganshin; John A Elefteriades Journal: Int J Angiol Date: 2017-08-24
Authors: Elizabeth L Norton; David M Williams; Karen M Kim; Xiaoting Wu; Minhaj S Khaja; Himanshu J Patel; G Michael Deeb; Bo Yang Journal: Ann Cardiothorac Surg Date: 2019-09
Authors: Simon C Y Chow; Randolph H L Wong; Ishan Lakhani; Michelle V Wong; Gary Tse; Peter S Y Yu; Jacky Y K Ho; Takuya Fujikawa; Malcolm J Underwood Journal: J Thorac Dis Date: 2020-03 Impact factor: 3.005