Aortic Dissection Without Intimal Tear (Aortic Intramural Hemorrhage): Its Incidence & Prognosis Associated with Medical Treatment

Hwang, Kyung Kuk; Park, Dae Gyun; Teun, Tae Jin; Cho, Young Seok; Sohn, Dae Won; Kim, Hyo Soo; Kim, Cheol Ho; Oh, Byung Hee; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo

Abstract

OBJECTIVES
This study was performed to verify the incidence and prognosis of aortic dissection without intimal tear(aortic intramural hemorrhage, IMH) who took only medical treatment in special reference to Stanford type A.
METHODS
We analysed the patients of IMH confirmed by TEE, CT, MRI, angiography or CT-angiography in Seoul National University Hospital between 1987 and 1995, retrospectively.
RESULTS
The diagnosis of IMH was established in 20 of 143 patients(14%). Nine patients were Stanford type A, 11 patients were type B. The longitudinal extent varied between 8 and 30cm, and IMH size varied between 10 and 30mm. Surgery was performed in two of type A patients because of persistent chest pain and one of type B patients because of progressive aortic dilatation despite of medical treatment. Follow-up imaging studies (mean follow-up period of 20.0+/-2.0 months) were done in 10/17 patients who were treated medically. Complete resolution of IMH was observed in seven cases, four of them were Stanford type A, and the mean size of IMH was 12mm(10-l7mm). Partial resolution was observed in one case, Stanford type A, with the IMH size of 15mm. There was no significant change in the size of IMH in two cases. Initial mean size of IMH was 25mm. In no case, aortic rupture or death was observed during the follow up period.
CONCLUSION
In the management of the patient with IMH, same surgical indications as classic aortic dissection have been advocated based on similar prognosis. However our study showed better prognosis in IMH patients treated medically compared to the previous publications. Therefore, even in cases of proximal IMH, medical treatment should be seriously considered.