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Ann Thorac Surg 2006;81:1587-1592
© 2006 The Society of Thoracic Surgeons
Department of Surgery 2, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
Accepted for publication December 8, 2005.
* Address correspondence to Dr Nakamura, Department of Surgery 2, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan (Email: shiori{at}med.miyazaki-u.ac.jp).
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.
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