Outcomes of medically treated patients with aortic intramural hematoma.
OBJECTIVE
Aortic intramural hematoma has been considered a precursor of aortic dissection, and the same treatment strategy, usually involving surgery, has been applied to both conditions. However, the outcomes of patients with aortic intramural hematoma who are treated medically, including the remodeling process that occurs after an acute event, are not known.


METHODS
A total of 124 patients with acute aortic intramural hematoma (41 in the proximal aorta and 83 in the distal aorta) was enrolled from five institutions in South Korea. Patients received medical treatment without surgery. A follow-up imaging study was performed in 105 patients.


RESULTS
Pericardial (59% [n = 24] vs. 11% [n = 9], P <0.004) and pleural effusions (63% [n = 26] vs. 45% [n = 37], P = 0.05) were more common in patients with the proximal type than in those with the distal type. In-hospital mortality was somewhat higher with proximal hematomas (7% [n = 3 deaths] vs. 1% [n = 1 death], P = 0.11). A follow-up imaging study in 36 patients with proximal hematomas confirmed resorption of the hematoma in 24 patients (67%) and development of aortic dissection in 9 (25%). Resorption was confirmed in 54 (78%) of the 69 patients with distal hematomas who underwent follow-up imaging; localized aortic dissection developed in 11 (16%) of these patients. The 3-year survival rate was 78% in the proximal type and 87% in the distal type (P = 0.10).


CONCLUSIONS
Patients with aortic intramural hematoma had a high rate of resorption with medical treatment regardless of the affected site. Further investigation is necessary to determine the optimal treatment strategy and timing of surgical intervention, especially for patients with proximal hematomas.
Division of Cardiology, Asan Medical Center, Seoul, South Korea. jksong@www.amc.seoul.kr
Jae-Kwan
JK
Song
Hyun-Sook
HS
Kim
Jong-Min
JM
Song
Duk-Hyun
DH
Kang
Jong-Won
JW
Ha
Se-Joong
SJ
Rim
Namsik
N
Chung
Kee-Sik
KS
Kim
Seung Woo
SW
Park
Yong Jin
YJ
Kim
Dae-Won
DW
Sohn
D000208:Acute Disease; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011336:Probability; D011856:Radiographic Image Enhancement; D012042:Registries; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome