Kaji Shuichiro, Akasaka Takashi, Horibata Yoko, Nishigami Kazuhiro, Shono Hiroyuki, Katayama Minako, Yamamuro Atsushi, Morioka Shigefumi, Morita Ichiro, Tanemoto Kazuo, Honda Takashi, Yoshida Kiyoshi
Division of Cardiovascular Medicine and Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
Circulation. 2002 Sep 24;106(12 Suppl 1):I248-52.
Recent studies have shown an favorable short-term prognosis of patients with type A acute aortic intramural hematoma (IMH). The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection (AD). The purpose of this study was to elucidate clinical features and long-term prognosis of patients with type A IMH.
Clinical data were compared retrospectively between 30 patients with acute type A IMH (IMH group) and 101 patients with acute type A AD (AD group) who were admitted to our institutions from 1988 to 1998. In AD group, 72 patients underwent surgical repair and 29 patients were treated medically. All patients in IMH group were treated initially with supportive medical therapy. Thirteen patients who demonstrated progression to AD or increase in size of hematoma underwent timed surgical repair except for 1 patient. The overall in-hospital mortality rate in IMH group was significantly lower than that in AD group (7% and 34%, P=0.004). Follow-up periods were 56+/-37 (IMH group) and 60+/-42 months (AD group), which revealed 1 and 6 late deaths, respectively. The actuarial survival rates in IMH group were all 90% at 1, 2, and 5 years, which were significantly higher than those in AD group (67%, 66%, and 62%, respectively; P=0.004).
Patients with type A IMH have better long-term prognosis than patients with AD.
近期研究显示，A型急性主动脉壁内血肿（IMH）患者具有良好的短期预后。与经典主动脉夹层（AD）相比，主动脉病理改变的差异可能对临床病程产生不同影响。本研究旨在阐明A型IMH患者的临床特征及长期预后。
回顾性比较1988年至1998年期间入住我院的30例急性A型IMH患者（IMH组）和101例急性A型AD患者（AD组）的临床资料。AD组中，72例患者接受了手术修复，29例患者接受了内科治疗。IMH组所有患者最初均接受支持性内科治疗。除1例患者外，13例出现向AD进展或血肿增大的患者接受了择期手术修复。IMH组的总体院内死亡率显著低于AD组（7%和34%，P = 0.004）。随访时间分别为56±37个月（IMH组）和60±42个月（AD组），分别有1例和6例晚期死亡。IMH组1年、2年和5年的精算生存率均为90%，显著高于AD组（分别为67%、66%和62%；P = 0.004）。
A型IMH患者的长期预后优于AD患者。
