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J Thorac Cardiovasc Surg 2002;124:894-895
© 2002 The American Association for Thoracic Surgery

Editorials

Management of intramural hematoma of the ascending aorta: Still room for debate

From the Mayo Clinic and Foundation, Rochester, Minn.

Received for publication April 30, 2002. Accepted for publication May 15, 2002. Address for reprints: Thoralf M. Sundt, MD, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905.

The first 20% of the full text of this article appears below.

	Introduction

 
See related article on page 918.

In this issue of the Journal, Moizumi and colleagues ¹ from Sendai City Medical Center and Tohoku University present a thought-provoking analysis of their experience with what would be considered by most Western surgeons an iconoclastic approach to the management of intramural hematoma of the ascending aorta (IMH). Applying an algorithm of expectant (I would not call it conservative) therapy to 33 patients with this condition during a 9-year interval, these authors have acquired what is to my knowledge the largest reported single-center experience with this uncommon entity. Their results are excellent. They challenge us to rethink our approach to this condition.

In the authors' series, only patients with cardiac tamponade, impending rupture (described as hemodynamic instability or persistent pain), rupture, or progression of the IMH underwent surgery. All others were treated medically with aggressive antihypertensive therapy and bed rest. Nine of 33 patients underwent early surgery with what can only be considered a highly acceptable mortality rate of 11%, given that 5 of the 9 patients were in shock on admission and 3 underwent total arch replacement. Early mortality in the medical group was also low at 5% (P not significant). During the follow-up . . . [Full Text of this Article]

Related Article

Management of patients with intramural hematoma involving the ascending aorta

Yoshimasa Moizumi, Tsunehiro Komatsu, Naotaka Motoyoshi, and Koichi Tabayashi
J. Thorac. Cardiovasc. Surg. 2002 124: 918-924. [Abstract] [Full Text] [PDF]

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