Clinical studyOutcomes of medically treated patients with aortic intramural hematoma☆
Section snippets
Methods
A database of patients with acute aortic syndrome from 1997 to 1999 was reviewed at each of five large referral centers in South Korea. Patients with acute aortic intramural hematoma who received medical treatment without surgical intervention during the acute stage (within 2 weeks after the onset of chest or back pain) were enrolled. During the study period, 3 patients with proximal hematomas underwent urgent surgical repair due to unstable hemodynamic condition within 24 hours after symptom
Results
A total of 124 patients were enrolled, 41 of whom showed involvement of the ascending aorta and were classified as the proximal type; the remaining 83 patients showed involvement of the descending aorta only and were classified as the distal type. The mean (± SD) age of the patients was 63 ± 10 years; more than three quarters had hypertension (Table 1). Pericardial and pleural effusions were more common in patients with the proximal type (Table 1). In-hospital mortality was somewhat greater
Discussion
In this multicenter study, we found that those patients with aortic intramural hematoma show high rates of resorption with medical treatment, regardless of the affected site. Typical aortic dissection develops only in a few patients, perhaps indicating that the absence of a direct-flow communication through an intimal tear in aortic intramural hematoma is a good prognostic finding. This is consistent with observations in classic aortic dissection, in which persistent flow in the false lumen
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This study was supported by a grant from the Korean Circulation Society (#98-7).