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Aortic intramural hemorrhage visualized by transesophageal echocardiography: findings and prognostic implications
S Mohr-Kahaly1, R Erbel, P Kearney
1II. Medical Clinic, Johannes Gutenberg University Mainz, Germany.
Insights
Aortic intramural hemorrhage, a variant of aortic dissection, can lead to severe complications. Transesophageal echocardiography is crucial for detecting this condition and monitoring patients for potential dissection or rupture.
Area of Science:
- Cardiovascular Imaging
- Aortic Diseases
- Diagnostic Echocardiography
Background:
- Aortic intramural hemorrhage is a variant of acute aortic dissection.
- It presents as layered thickening of the aortic wall without a communication or intimal flap.
- Autopsy studies suggest it results from vasa vasorum rupture, seen in 5-10% of dissection cases.
Purpose of the Study:
- To describe transesophageal echocardiographic findings in patients with aortic intramural hemorrhage.
- To report on the follow-up outcomes of these patients.
Main Methods:
- Prospective transesophageal echocardiographic study.
- Included 114 patients with aortic dissection between 1986 and 1991.
- Aortic intramural hemorrhage diagnosed in 15 patients, confirmed anatomically or by follow-up.
Main Results:
- Affected patients were elderly (mean age 70) with hypertension.
- Ascending aorta involved in 3, descending in 12.
- 33% developed classic aortic dissection, 27% rupture.
- 53% died within 11 months due to aortic disease complications.
Conclusions:
- Aortic intramural hemorrhage is a variant of aortic dissection.
- It can be an early sign of developing dissection or rupture.
- Transesophageal echocardiography is highly effective for diagnosis and monitoring.
Objectives:
This study describes the transesophageal echocardiographic and follow-up findings in patients with aortic intramural hemorrhage.
Background:
Localized aortic intramural hemorrhage resulting in layered thickening of the aortic wall seems to represent a variant of acute aortic dissection without communication or a typical moving intimal flap. In autopsy studies this variant, attributed to a rupture of the vasa vasorum, has been described in 5% to 10% of patients with dissection.
Methods:
In a prospective transesophageal echocardiographic study in patients with aortic dissection performed between 1986 and 1991, the diagnosis of intramural hemorrhage was established in 15 of 114 patients and either confirmed anatomically (7 patients) with an additional diagnostic imaging technique or on the basis of clear follow-up changes (8 patients).
Results:
Elderly patients (mean age 70 years) with a history of hypertension were affected by this variant of dissection. The ascending aorta was involved in 3 patients and the descending aorta in 12. The longitudinal extent varied between 3 and 20 cm, and wall thickness varied between 0.7 and 3 cm. Classic aortic dissection developed in five patients (33%) and rupture in four (27%). Regression of aortic wall thickening was noted in two patients, whereas three patients became asymptomatic without apparent wall changes (33%). Surgery was performed in 5 patients, whereas medical therapy was continued in 10. During a mean follow-up period of 11 months, eight patients (53%) died because of complications of the aortic disease.
Conclusions:
Intramural hemorrhage represents a variant of aortic dissection and may be an early finding in patients who develop classic aortic dissection or rupture. Transesophageal echocardiography is an excellent method for the detection of intramural hemorrhage and for monitoring these patients.