Clinical significance of echo-free space detected by transesophageal echocardiography in patients with type B aortic intramural hematoma

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Abstract

To evaluate the prevalence and clinical significance of echo-free space (EFS) in aortic intramural hematoma (AIH) during transesophageal echocardiography (TEE), TEE performed during the acute phase in 71 consecutive patients with type B AIH was reviewed. Forty-four patients (62%) had EFS including 24 patients with a large EFS occupying >1/2 of the hematoma thickness. Among 59 patients who also underwent computed tomography, focal contrast enhancement in the hematoma area was observed in only 7 patients with a large EFS. Hospital mortality and incidence of surgical intervention in patients with EFS were 0% and 2%, respectively, which was similar to 4% in those without EFS. Follow-up imaging studies in 57 patients (80%) revealed development of typical aortic dissection (AD) in 6 patients and complete resorption of hematoma in 35; the incidence of either the development of AD or a complete resorption of hematoma was not significantly different between those with and without EFS. EFS by TEE is not rare in patients with type B AIH. It is not a poor prognostic factor and is not associated with the development of AD.

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Patient characteristics:

The study group consisted of 71 consecutive patients (44 men and 27 women between the ages of 39 and 77 years, mean 63) who were diagnosed with type B distal AIH on TEE from May 1994 to October 2000. All patients had sudden chest or back pain within 2 days before admission. In all patients, TEE showed a longitudinally oriented crescentic aortic wall thickening within the descending aorta. In 59 patients (83%), CT was also available for comparison, which was done during the acute phase.

All

Prevalence of EFS in TEE and contrast enhancement in CT:

Among 71 patients with distal AIH, 44 (62%) had EFS on the initial transesophageal echocardiogram. According to the criteria mentioned above, 24 patients (34%) were classified as group A, 20 (28%) as group B, and 27 (38%) as group C. Table 1summarizes the clinical characteristics and outcomes of the patients. Mean age, sex ratio, initial maximal aortic diameter, maximal aorta cross-sectional area, and maximal hematoma thickness were not significantly different between patients with (n = 44) and

Discussion

In this study, we have shown that EFS on TEE was not uncommon in patients with acute type B AIH, and a large amount of EFS was associated with a higher incidence of focal contrast enhancement by CT obtained during the acute phase. Nevertheless, the presence of EFS did not appear to be a predictor of either the development of AD or poor clinical outcome in patients with type B AIH.

The overall prevalence of EFS in our patients with distal AIH was 62% (44 of 71), which is very similar to

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