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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Type A intramural hematoma often turns out to be a type A dissection
Sebastian Michel1, Christian Hagl1, Gerd Juchem1
1Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany.
The Heart Surgery Forum
|December 28, 2013
Summary
Immediate surgical repair is recommended for type A intramural hematoma (IMH) of the aorta. This condition can often be a misdiagnosed thrombosed type A aortic dissection, requiring urgent intervention.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Diagnostic Imaging
Background:
- Management of type A intramural hematoma (IMH) remains controversial.
- Western guidelines recommend immediate surgical repair, while some Asian centers report success with medical management.
- This case highlights a potential diagnostic challenge in type A IMH.
Purpose of the Study:
- To present a case of type A IMH that was intraoperatively identified as a thrombosed type A aortic dissection.
- To emphasize the importance of surgical intervention in suspected type A IMH.
Main Methods:
- A case report of an 83-year-old female with acute chest pain.
- Computed tomography revealed type A IMH; however, no intimal flap was detected.
- Surgical replacement of the ascending aorta was performed.
Main Results:
- Intraoperative findings revealed a ruptured intimal plaque causing aortic dissection with a thrombosed false lumen.
- Computed tomography and transesophageal echocardiography failed to identify the dissection accurately.
- The condition was confirmed as a thrombosed type A dissection, not IMH.
Conclusions:
- Type A IMH should be treated with immediate surgical repair due to the high likelihood of it being a thrombosed type A dissection.
- Accurate preoperative diagnosis of type A IMH versus dissection can be challenging.
- Prompt surgical intervention is crucial for favorable outcomes in these complex aortic pathologies.
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