title: Clinical outcomes of medical therapy and timely operation in initially diagnosed type a aortic intramural hematoma: a 20-year experience.
abstract: BACKGROUND
  The management of aortic intramural hematoma (IMH) involving the ascending aorta (type A) has not been well-established. The purpose of this study was to clarify the long-term clinical outcomes of patients with type A IMH who were treated with medical therapy and timely operation.
  
  
  RESULTS
  Clinical data including operative mortality, IMH-related events, and long-term survival were retrospectively reviewed in 66 patients with type A IMH, who were admitted to our institution from 1986 to 2006. Emergent surgical repair was performed in 16 (24%) patients because of severe complications, whereas 50 patients were treated with initial medical therapy. In medically treated patients, 15 (30%) patients who demonstrated progression to classic dissection or increase in hematoma size within 30 days underwent surgical repair except for 2 patients who refused surgery. The 30-day mortality rate was 6% with emergent surgery and 4% with supportive medial therapy. There were 7 late deaths and the actuarial survival rates of all patients were 96+/-3%, 94+/-3%, and 89+/-5% at 1, 5, and 10 years, respectively. In medically treated patients, maximum aortic diameter was the only predictor of early and late progression of ascending IMH (hazard ratio, 4.43; 95% CI, 2.04-9.64; P<0.001). Aortic diameter > or =50 mm predicted progression of ascending IMH with the positive and negative value of 83% and 84%, respectively.
  
  
  CONCLUSIONS
  Combination of medical therapy and timely operation resulted in favorable long-term clinical outcomes in patients with type A IMH.
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Kaji
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamamuro
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tani
authors.forename: Koichi
authors.initials: K
authors.lastname: Tamita
authors.forename: Makoto
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Ehara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Michihiro
authors.initials: M
authors.lastname: Nasu
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology; D001014:Aortic Aneurysm / Q000209:etiology; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies