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Tailored treatment modality in acute type A intramural hematoma

Authors
 Myeong Su Kim  ;  Tae-Hoon Kim  ;  Ha Lee  ;  Suk-Won Song  ;  Kyung-Jong Yoo 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.166(5) : 1400-1410, 2023-11 
Journal Title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN
 0022-5223 
Issue Date
2023-11
MeSH
Aorta / pathology ; Aorta, Thoracic / diagnostic imaging ; Aorta, Thoracic / pathology ; Aorta, Thoracic / surgery ; Aortic Diseases* / diagnostic imaging ; Aortic Diseases* / pathology ; Aortic Diseases* / surgery ; Aortic Dissection* / diagnostic imaging ; Aortic Dissection* / surgery ; Hematoma / diagnostic imaging ; Hematoma / etiology ; Hematoma / surgery ; Humans ; Retrospective Studies ; Related informati
Keywords
aortic intramural hematoma ; computed tomography ; hematoma thickness ratio ; intimal tear ; major adverse aortic event ; penetrating aortic ulcer ; ulcer-like projection
Abstract
Objectives: Intramural hematoma may be generated by a minimal intimal tear. Most surgeries for acute type A intramural hematoma are performed on the proximal aorta alone regardless of the intimal tear site. Under the assumption that major adverse aortic events (MAAEs) would be related to the location of primary intimal tear, we reviewed preoperative computed tomography scan findings. Methods: Sixty patients with acute type A intramural hematoma who underwent surgery from January 2008 to December 2019 were retrospectively analyzed. The maximal diameter, maximal thickness of the intramural hematoma, and hematoma thickness ratio of the ascending and descending aortae were measured. MAAEs were defined as newly developed aortic dissection, rupture, newly developed penetrating aortic ulcer (PAU), enlargement of the PAU, and aortic death. Results: The number of patients with PAU in the descending aorta (dPAU) was significantly higher in the MAAE (+) group. The MAAE (+) group showed lower measurements of the ascending aorta and higher measurements of the descending aorta than the MAAE (?) group. In the univariate analysis, dPAU, hematoma thickness ratio of the ascending and descending aortae, and descending aorta hematoma thickness >8.58 mm were risk factors of MAAE. Intimal tear noted intraoperatively and ascending aorta hematoma thickness >10.25 mm were protective factors of MAAE. Conclusions: Aortopathies (ie, PAU, ulcer-like projections, and the hematoma thickness ratio) are important clues to determine the location of intimal tear. Occurrence of MAAEs seems to be highly related to the pathology of the descending aorta. The modalities of treatment for stable acute type A intramural hematoma that do not meet the existing guidelines should be tailored to the location of the intimal tear.
Full Text
https://www.sciencedirect.com/science/article/pii/S0022522322001155
DOI
10.1016/j.jtcvs.2022.01.037
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Tae Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-3987-0057
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Lee, Ha(이해)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197896
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