Gülmez Ö, Saritas B, Isiklar I
Department of Cardiology, Baskent University Istanbul Medical and Research Center, Istanbul, Turkey.
Department of Cardiovascular Surgery, Baskent University Istanbul Medical and Research Center, Istanbul, Turkey.
Niger J Clin Pract. 2017 Nov;20(11):1513-1515. doi: 10.4103/njcp.njcp_21_17.
Intramural hematoma (IMH) of ascending aorta is a rare but potentially lethal form of acute aortic syndrome (AAS). It is characterized by a hematoma within the media layer of the aorta secondary to rupture of the vasa vasorum in the absence of an intimal tear. However, the theory of "micro-tear" which cannot be easily detected has been raised. It may stabilize, regress, or progress to rupture or dissection. Similar to Type A aortic dissection (AD), patients with IMH of ascending aorta, as well as patients with persistent pain, are treated urgent surgery. We report a case of an ascending aorta IMH in a patient admitted to hospital with epigastric and chest pain with ST-elevation myocardial infarction in inferior leads. Coronary angiography (CAG) was performed and contrast injection from the right coronary artery (RCA) ostium showed marked contrast enhancement of the aortic wall. The CAG was terminated with a suspicion of Type A AD. The diagnosis of IMH starting just above RCA ostium with a thickness of 18 mm was made with computed tomographic angiography. An emergent surgical repair of the aorta and one-vessel coronary artery bypass graft surgery was performed successfully in our patient.
升主动脉壁内血肿（IMH）是一种罕见但可能致命的急性主动脉综合征（AAS）形式。其特征是在没有内膜撕裂的情况下，由于滋养血管破裂，主动脉中膜层内出现血肿。然而，“微撕裂”理论已被提出，这种撕裂不易被检测到。它可能稳定、消退或进展为破裂或夹层。与A型主动脉夹层（AD）类似，升主动脉IMH患者以及持续疼痛的患者需接受紧急手术治疗。我们报告一例因上腹部和胸痛伴下壁导联ST段抬高型心肌梗死入院的患者发生升主动脉IMH。进行了冠状动脉造影（CAG），从右冠状动脉（RCA）开口处注射造影剂显示主动脉壁明显强化。因怀疑A型AD终止了CAG检查。通过计算机断层血管造影确诊为起始于RCA开口上方、厚度为18mm的IMH。我们的患者成功接受了主动脉紧急手术修复和单支血管冠状动脉旁路移植手术。
