Document Detail

Clinical analysis of acute type A intramural hematoma: comparison between two different pathophysiological types.
MedLine Citation:
PMID:  16631639     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Type A intramural hematoma (IMH) has two different etiologies, which are rupture of vasa vasorum and penetrating atherosclerotic ulcer (PAU); however, it is difficult to know which is the initiating event. METHODS: Between January 1993 and August 2004, 28 patients of acute type A IMH were treated in our department and were divided into two groups, 20 patients with IMH probably caused by rupture of vasa vasorum (non-PAU group) and 8 patients with IMH probably caused by PAU (PAU group), according to pathologic specimen and atherosclerotic findings on computed tomography. Background factors, radiographic findings, and prognosis were analyzed retrospectively. RESULTS: Surgery was performed in 15 patients (75%) in non-PAU group and 4 patients (50%) in PAU group during the first admission. Late progression was noted in 3 patients, and operation was required. Finally, operation was performed in 22 patients (78.6%). The history of myocardial infarction (p = 0.026) and chronic renal failure (p = 0.026) were more associated with PAU group than with non-PAU group. Ascending aortic diameter at the onset was significantly larger in non-PAU group (50.3 +/- 6.6 mm) than in PAU group (43.9 +/- 9.0 mm; p = 0.046), and there were significantly more ulcer lesions in PAU group (1.9 +/- 0.4) than in non-PAU group (1.1 +/- 0.4; p = 0.0004). There was no significant difference in long-term survival rates between them. CONCLUSIONS: The PAU group patients have more coexisting atherosclerotic diseases and multiple aortic ulcer lesions with significantly mild ascending aortic dilatation compared with non-PAU group patients.
Kunihide Nakamura; Toshio Onitsuka; Mitsuhiro Yano; Yoshikazu Yano; Masakazu Matsuyama; Kazushi Kojima
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  81     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-05-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1587-92     Citation Subset:  AIM; IM    
Department of Surgery 2, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
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MeSH Terms
Age Factors
Aged, 80 and over
Aneurysm, Dissecting / epidemiology,  physiopathology*,  radiography,  surgery
Aortic Rupture / complications*,  radiography
Arteriosclerosis / complications,  epidemiology
Disease Progression
Hematoma / etiology*,  physiopathology
Kidney Failure, Chronic / epidemiology
Middle Aged
Myocardial Ischemia / epidemiology
Retrospective Studies
Tomography, X-Ray Computed
Tunica Intima / pathology
Ulcer / pathology
Vasa Vasorum / pathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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