Document Detail

Clinical outcomes of medical therapy and timely operation in initially diagnosed type a aortic intramural hematoma: a 20-year experience.
MedLine Citation:
PMID:  19752382     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The management of aortic intramural hematoma (IMH) involving the ascending aorta (type A) has not been well-established. The purpose of this study was to clarify the long-term clinical outcomes of patients with type A IMH who were treated with medical therapy and timely operation. METHODS AND RESULTS: Clinical data including operative mortality, IMH-related events, and long-term survival were retrospectively reviewed in 66 patients with type A IMH, who were admitted to our institution from 1986 to 2006. Emergent surgical repair was performed in 16 (24%) patients because of severe complications, whereas 50 patients were treated with initial medical therapy. In medically treated patients, 15 (30%) patients who demonstrated progression to classic dissection or increase in hematoma size within 30 days underwent surgical repair except for 2 patients who refused surgery. The 30-day mortality rate was 6% with emergent surgery and 4% with supportive medial therapy. There were 7 late deaths and the actuarial survival rates of all patients were 96+/-3%, 94+/-3%, and 89+/-5% at 1, 5, and 10 years, respectively. In medically treated patients, maximum aortic diameter was the only predictor of early and late progression of ascending IMH (hazard ratio, 4.43; 95% CI, 2.04-9.64; P<0.001). Aortic diameter > or =50 mm predicted progression of ascending IMH with the positive and negative value of 83% and 84%, respectively. CONCLUSIONS: Combination of medical therapy and timely operation resulted in favorable long-term clinical outcomes in patients with type A IMH.
Takeshi Kitai; Shuichiro Kaji; Atsushi Yamamuro; Tomoko Tani; Koichi Tamita; Makoto Kinoshita; Natsuhiko Ehara; Atsushi Kobori; Michihiro Nasu; Yukikatsu Okada; Yutaka Furukawa
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-15     Completed Date:  2009-10-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S292-8     Citation Subset:  AIM; IM    
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan.
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MeSH Terms
Aneurysm, Dissecting / etiology
Aortic Aneurysm / etiology
Aortic Diseases / complications,  mortality,  therapy*
Disease Progression
Follow-Up Studies
Hematoma / complications,  mortality,  therapy*
Middle Aged
Retrospective Studies

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