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Ann Thorac Surg 2005;79:1518-1521
© 2005 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Pathologic Characteristics and Surgical Indications of Superacute Type A Intramural Hematoma

^a Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
^b Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
^c Critical Care and Emergency Medical Center, Yokohama City University Medical Center, Yokohama, Japan

Accepted for publication November 10, 2004.

^_* Address reprint requests to Dr Uchida, Cardiovascular Center, Yokohama City Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan (E-mail: uchida{at}urahp.yokohama-cu.ac.jp).

BACKGROUND: The treatment policy for acute intramural hematoma involving the ascending aorta remains controversial.

METHODS: This study compared the pathologic characteristics of intramural hematoma with those of acute aortic dissection with a false lumen. The study group comprised 69 patients with intramural hematoma and 156 with acute aortic dissection who underwent emergency operation between 1995 and 2003.

RESULTS: Patients were significantly older in the intramural hematoma group than in the dissection group (67.7 ± 7.2 years compared with 59.8 ± 11.6 years; p < 0.0001). Pericardial hemorrhage was present in a higher proportion of patients in the intramural hematoma group than in the dissection group (66.7% compared with 50.6%; p = 0.0257). Three patients (4.3%) died in the intramural hematoma group, whereas 26 patients (16.7%) died in the dissection group (p = 0.011). Histopathologic examination showed no difference in the severity of medial changes, but the site of dissection differed. The thickness of the residual media of the adventitia side was 0.21 ± 0.12 mm in the intramural hematoma group compared with 0.32 ± 0.22 mm in the acute aortic dissection group. Dissection was significantly nearer the adventitia in the intramural hematoma group (p = 0.0016).

CONCLUSIONS: Dissection is nearer the adventitia in intramural hematoma than in dissection, leading to a greater probability of rupture. These results suggest that operation as soon as possible after the onset of intramural hematoma will contribute to improved survival.

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