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Transesophageal echocardiographic and clinical features of aortic intramural hematoma
K M Harris1, A C Braverman, F R Gutierrez
1Cardiovascular Division, Washington University School of Medicine, St. Louis, Mo 63110, USA.
Insights
Transesophageal echocardiography reveals distinct features of aortic intramural hematoma. Surgical intervention for ascending aortic intramural hematoma significantly reduces 30-day mortality compared to medical management.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
Background:
- Aortic intramural hematoma (IMH) is a variant of aortic dissection.
- Understanding its echocardiographic features and natural history is crucial for patient management.
Purpose of the Study:
- To identify the transesophageal echocardiographic (TEE) characteristics of aortic IMH.
- To describe the natural history and outcomes of patients with aortic IMH.
Main Methods:
- Retrospective review of TEE studies in patients with suspected aortic dissection over 6 years.
- Measurement of involved aortic segments and clinical follow-up.
Main Results:
- Ascending aortic IMH segments (7±2 mm) were thinner than descending segments (15±6 mm).
- Echolucent areas and displaced intimal calcium were common findings.
- Ascending IMH: 50% 30-day mortality with medical vs. 0% with surgical treatment.
- Descending IMH: 100% survival at 30 days for medical vs. 86% for surgical treatment.
Conclusions:
- Aortic IMH exhibits specific TEE features.
- High morbidity and mortality are associated with aortic IMH, particularly in the ascending aorta.
Objective:
This study sought to determine the transesophageal echocardiographic features and natural history of patients with aortic intramural hematoma.
Methods:
The transesophageal echocardiograms of all patients who had symptoms indicative of aortic dissection over 6 years were reviewed. Measurements were made of the involved aortic segment in the study patients, and follow-up was obtained.
Results:
In patients with aortic intramural hematoma, the wall thickness of the involved segment was significantly greater for descending segments than ascending segments (ascending aorta 7 +/- 2 mm, descending aorta 15 +/- 6 mm, p = 0.0016). In each case, the crescent-shaped intramural hematoma involved one wall predominantly, leading to compression of the aortic lumen. The findings of echolucent areas and displaced intimal calcium were found in the majority of patients. Four of eight patients with intramural hematoma of the ascending aorta were treated medically and four were treated surgically. The 30-day mortality was 50% in the medically treated patients and 0% in the surgically treated group. Four of 11 patients with isolated intramural hematoma of the descending aorta were treated medically and seven were treated surgically. All medically treated and 86% of surgically treated patients were alive at 30 days.
Conclusions:
Aortic intramural hematoma has distinct and identifiable transesophageal echocardiographic features. These data support those of previous studies documenting high morbidity and mortality in patients with aortic intramural hematoma.