title: Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta.
abstract: OBJECTIVE
  The goal of this study was to test the hypothesis that the absence of direct flow communication through intimal tear in aortic intramural hematoma (AIH) involving the ascending aorta has different clinical impact on clinical course compared with typical aortic dissection (AD).
  
  
  BACKGROUND
  Although emergent surgical repair has been applied for patients with proximal AIH as if it was typical AD, the natural history of proximal AIH is not known clearly yet.
  
  
  METHODS
  Direct comparison of the clinical data of 81 patients with proximal AD and 24 patients with AIH was performed retrospectively.
  
  
  RESULTS
  Patients with AIH were older (67 +/- 10 vs. 50 +/- 13, p = 0.001), and female gender was more predominant in AIH (19/24 vs. 29/81, p = 0.001). The development of mediastinal hemorrhage and pericardial and pleural effusion was more frequent in patients with AIH than it was in patients with AD. Although medical treatment was more frequently selected in the AIH group (75% vs. 15%, p = 0.001) due to old age and other associated medical diseases, the mortality rate with medical treatment was much lower in patients with AIH than it was in patients with AD (6% vs. 58%, p = 0.003). In follow-up imaging studies of 13 patients who survived AIH without surgical repair, seven patients showed complete resolution. Typical AD developed in three patients, and the other three patients showed focal AD only in the descending aorta. The two-year survival rate did not show significant difference (84% +/- 6% in AIH vs. 76% +/- 17% in AD, p = 0.47).
  
  
  CONCLUSIONS
  Absence of continuous flow communication can explain a more favorable clinical course of AIH than for AD, and medical treatment with frequent imaging follow-up and timed elective surgery in cases with complications can be a rational option for patients with proximal AIH.
authors.affiliation: Division of Cardiology, University of Ulsan, College of Medicine, Seoul, Korea. jksong@www.amc.seoul.kr
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: D H
authors.initials: DH
authors.lastname: Kang
authors.forename: T H
authors.initials: TH
authors.lastname: Lim
authors.forename: M G
authors.initials: MG
authors.lastname: Song
authors.forename: S W
authors.initials: SW
authors.lastname: Park
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D017677:Age Distribution; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D015897:Comorbidity; D003937:Diagnosis, Differential; D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome