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J Thorac Cardiovasc Surg 2004;127:421-427
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta

^a Division of Cardiovascular Surgery, Sendai City Medical Center, Sendai, Japan
^b Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan

Received for publication June 19, 2003; revisions received September 8, 2003; accepted for publication September 16, 2003.

^* Address for reprints: Yoshimasa Moizumi, MD, the Division of Cardiovascular Surgery, Sendai, City Medical Center, 5-22-1 Turugaya, Miyaginoku, Sendai, Miyagiken, Japan
moizumi{at}openhp.or.jp

OBJECTIVE: Most previous reports on intramural hematoma of the aorta have focused on the initial episode. The purpose of this study was to clarify the long-term outcome of intramural hematoma of the aorta.

METHODS: Ninety-four cases of intramural hematoma of the aorta (41 type A and 53 type B) were reviewed. There were 69 male and 25 female patients, and their mean age was 66.7 ± 8.7 years (range, 46-88 years).

RESULTS: Eleven (27%) of the patients with type A hematoma and 1 (2%) of the patients with type B hematoma underwent early surgical intervention. Others were treated medically, and the overall hospital mortality was 7% for patients with type versus 2% for patients with type B intramural hematomas of the aorta (P = .315). Twenty-three patients, 9 (22%) with type A and 14 (26%) with type B intramural hematomas of the aorta, underwent late surgical intervention during the follow-up period, and there were no hospital deaths. A total of 23 patients died during the follow-up period, including 6 of intramural hematoma of the aorta–related deaths (3 in the type A group and 3 in the type B group). The estimated freedom from intramural hematoma of the aorta–related events at 1 and 5 years was 70% ± 8% and 54% ± 11% for the type A group versus 73% ± 6% and 58% ± 8% for the type B group, respectively (P = .972). After excluding the nonintramural hematoma of the aorta–related deaths, the survival rates at 5 and 10 years were 80% ± 9% and 80% ± 9% for the type A group and 91% ± 8% and 81% ± 11% for the type B group (P = .211).

CONCLUSIONS: Intramural hematoma of the aorta–related events occur equally in both types of intramural hematoma of the aorta. We recommend close follow-up for at least 5 years because most intramural hematoma of the aorta–related events occur during this period.

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