title: Type A aortic intramural hematoma: clinical features and outcomes in Chinese patients.
abstract: BACKGROUND
  The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH).
  
  
  RESULTS
  We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of acute IMH by comparing these patients with those diagnosed with classical aortic dissection (AD). A total of 34 patients had IMH and they tended to be older (69.7 ± 12.4 versus 60.5 ± 16.2 years; p=0.006). The development of pericardial effusion was more frequent in patients with IMH than in patients with AD. They were also less likely to receive surgery as compared to AD patients (26.5% versus 73.2%; p<0.0001). Overall mortality of IMH was not significantly higher than that of classic AD (29.4% versus 21.4%; p=0.45). For IMH patients, the mortality rate with medical treatment was 32%. Ten (40%) of the 25 medically treated patients developed adverse outcomes. However, no independent predictors of adverse outcomes were identified in the study. In follow-up imaging studies of 15 patients who survived IMH without surgical repair, 14 patients showed complete resolution of IMH and 1 progressed into classical AD.
  
  
  CONCLUSIONS
  Acute type A IMH in Chinese patients showed a high mortality rate with medical treatment. It has a highly unpredictable course with no reliable clinical and anatomical predictors. Surgical therapy should be the treatment of choice for Chinese patients with acute IMH, especially those who are younger and have less comorbidities.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China. heehwa@attglobal.net
authors.forename: Hee Hwa
authors.initials: HH
authors.lastname: Ho
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Cheung
authors.forename: Man Hong
authors.initials: MH
authors.lastname: Jim
authors.forename: Kin Man
authors.initials: KM
authors.lastname: Miu
authors.forename: Chung Wah
authors.initials: CW
authors.lastname: Siu
authors.forename: Yui Ming
authors.initials: YM
authors.lastname: Lam
authors.forename: Hon Wah
authors.initials: HW
authors.lastname: Chan
authors.forename: Wai Luen
authors.initials: WL
authors.lastname: Lee
authors.forename: Hung Fat
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D044466:Asian People; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome