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Tailored treatment modality in acute type A intramural hematoma
Myeong Su Kim1, Tae-Hoon Kim1, Ha Lee1
1Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
The Journal of Thoracic and Cardiovascular Surgery
|February 28, 2022
Summary
Major adverse aortic events (MAAEs) in acute type A intramural hematoma are linked to the descending aorta's pathology. Tailoring treatment to the intimal tear location, especially in the descending aorta, is crucial for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Aortic Diseases
- Medical Imaging
Background:
- Acute type A intramural hematoma often involves surgery on the proximal aorta.
- The primary intimal tear site's influence on major adverse aortic events (MAAEs) is not fully understood.
- Preoperative computed tomography (CT) findings may predict MAAEs.
Approach:
- Retrospective analysis of 60 patients with acute type A intramural hematoma.
- Measured hematoma diameter, thickness, and ratio in ascending and descending aortae.
- Defined MAAEs including dissection, rupture, penetrating aortic ulcer (PAU), and aortic death.
Key Points:
- Descending aortic penetrating aortic ulcers (dPAU) were more common in patients experiencing MAAEs.
- Lower ascending aorta measurements and higher descending aorta measurements were observed in the MAAE group.
- Descending aorta hematoma thickness >8.58 mm and dPAU were identified as risk factors for MAAEs.
Conclusions:
- Aortopathies like PAU and hematoma thickness ratio indicate intimal tear location.
- MAAEs appear strongly associated with descending aorta pathology.
- Treatment for acute type A intramural hematoma should be individualized based on intimal tear site.
