A型壁内血肿的药物治疗还是手术治疗？
Medical Treatment or Surgery for Type A Intramural Hematoma?
作者信息
Tabesh Faezeh, Mirmohammadsadeghi Mohsen, Nasri Ali, Amini Mohammad, Sahebzade Mohammadsadegh
机构信息
Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
JACC Case Rep. 2025 May 7;30(9):103277. doi: 10.1016/j.jaccas.2025.103277. Epub 2025 Feb 26.
BACKGROUND
Type A intramural hematoma (IMH) is a cardiovascular emergency with high mortality and morbidity rates. Emergency surgery remains the preferred management option.
CASE SUMMARY
A 50-year-old woman was admitted with a chief complaint of chest pain and evidence of aortic dissection in transthoracic echocardiography. Computed tomographic angiography (CTA) showed IMH from the aortic root to the suprarenal arteries. In the absence of high mortality risk factors, medical treatment and follow-up studies were chosen for this patient. CTA was repeated at 3-month intervals for 1 year, and by the end of this period the IMH was completely resolved. WHY BEYOND THE GUIDELINES?: Guidelines recommend emergency surgical intervention for type A IMH. This report presents evidence of successful medical treatment for type A IMH.
DISCUSSION
This case report showed that medical management with follow-up imaging studies can be considered as the first option in selected patients with type A IMH.
背景
A型壁内血肿（IMH）是一种心血管急症，死亡率和发病率都很高。急诊手术仍然是首选的治疗方案。
病例摘要
一名50岁女性因胸痛入院，经胸超声心动图检查显示有主动脉夹层的证据。计算机断层血管造影（CTA）显示从主动脉根部到肾上腺动脉的壁内血肿。由于不存在高死亡风险因素，该患者选择了药物治疗和随访研究。在1年的时间里，每3个月重复进行一次CTA检查，到这段时间结束时，壁内血肿已完全消退。为何超出指南？：指南推荐对A型IMH进行急诊手术干预。本报告展示了A型IMH药物治疗成功的证据。
讨论
本病例报告表明，对于部分A型IMH患者，采用随访影像学检查的药物治疗可被视为首选方案。
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