急性A型主动脉壁内血肿与A型主动脉夹层：内膜撕裂特征与发病机制之间的相关性
Acute type A aortic intramural hematoma and type A aortic dissection: correlation between the intimal tear features and pathogenesis.
作者信息
Li Yu, Zhang Nan, Xu Shangdong, Fan Zhanming, Zhu Junming, Huang Lianjun, Chen Dong, Sun Zhonghua, Sun Lizhong
机构信息
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China.
出版信息
Quant Imaging Med Surg. 2020 Jul;10(7):1504-1514. doi: 10.21037/qims-20-191.
BACKGROUND
To determine the prevalence, clinical and imaging features of intimal tear detected by ECG-gated multidetector computed tomography (MDCT) and confirmed by surgery in patients with acute type A intramural hematoma (ATAIMH) and acute type A aortic dissection (AAAD).
METHODS
This retrospective study involved analysis of the intimal tear characteristics in 72 consecutive patients with ATAIMH and 209 with AAAD who were diagnosed by MDCT. The size and location of the intimal tear were measured and compared between these two groups of patients. The findings were also compared with those from 28 patients with ATAIMH who underwent surgical treatment to determine the intimal tear features as observed on CT angiography (CTA).
RESULTS
Patients in the ATAIMH group were significantly older than those in the AAAD group (58.6±11.3 . 49.4±12.8 years, P<0.001), and females were predominant in the former category (ATAIMH AAAD: 44.4% . 27.8%, P<0.01). Marfan syndrome and pregnancy were associated with most of the occurrences of AAAD. Sixty-four patients (88.9%) with ATAIMH were recognized as having intimal tear in the CTA images. The number of aortic segments in the ATAIMH patients was smaller than that in the AAAD patients (4.45±1.56 . 5.04±1.72 segments, P<0.01). The distribution of the intimal tear did not show any difference between the two groups. During the surgery, pericardial hemorrhage was observed in a higher proportion of patients in the ATAIMH than in the AAAD group (60.7% . 22.1%; P<0.01). In the former category, all of the intimal tears detected using CTA were confirmed during the operation, and the size was significantly larger than measured on the CTA images (6.95±5.12 19.59±6.51 mm, P<0.001). Six ATAIMH patients progressed to classical aortic dissection (AD) at surgery.
CONCLUSIONS
Patients with ATAIMH have a high prevalence of intimal tear, which is significantly smaller than that measured in patients with classic AAAD. Just like AD, ATAIMH may also be triggered by intimal tear. Hence, timely surgical repair is needed.
背景
确定心电图门控多排螺旋计算机断层扫描（MDCT）检测到并经手术证实的急性A型壁内血肿（ATAIMH）和急性A型主动脉夹层（AAAD）患者内膜撕裂的患病率、临床及影像学特征。
方法
这项回顾性研究分析了72例连续的ATAIMH患者和209例AAAD患者的内膜撕裂特征，这些患者均由MDCT诊断。测量并比较两组患者内膜撕裂的大小和位置。研究结果还与28例接受手术治疗的ATAIMH患者的CT血管造影（CTA）结果进行比较，以确定内膜撕裂特征。
结果
ATAIMH组患者明显比AAAD组患者年龄大（58.6±11.3岁对49.4±12.8岁，P<0.001），且前一组女性居多（ATAIMH对AAAD：44.4%对27.8%，P<0.01）。马凡综合征和妊娠与大多数AAAD病例相关。64例（88.9%）ATAIMH患者在CTA图像上被识别出有内膜撕裂。ATAIMH患者的主动脉节段数比AAAD患者少（4.45±1.56节段对5.04±1.72节段，P<0.01）。两组内膜撕裂的分布无差异。手术中，ATAIMH组心包出血患者的比例高于AAAD组（60.7%对22.1%；P<0.01）。在前一组中，CTA检测到的所有内膜撕裂在手术中均得到证实，且大小明显大于CTA图像上测量的结果（6.95±5.12毫米对19.59±6.51毫米，P<0.001）。6例ATAIMH患者在手术中进展为典型主动脉夹层（AD）。
结论
ATAIMH患者内膜撕裂的患病率较高，明显小于经典AAAD患者。与AD一样，ATAIMH也可能由内膜撕裂引发。因此，需要及时进行手术修复。
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