Acute type A aortic intramural hematoma and type A aortic dissection: correlation between the intimal tear features and pathogenes
MetadataShow full item record
This article is originally published in Quantitative Imaging in Medicine and Surgery. 10 (7): pp. 1504-1514. http://dx.doi.org/10.21037/qims-20-191
Background: To determine the prevalence, clinical and imaging features of intimal tear detected by ECGgated 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 vs. 49.4±12.8 years, P<0.001), and females were predominant in the former category (ATAIMH vs. AAAD: 44.4% vs. 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 vs. 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% vs. 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 (6.96±5.12 to 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.
Showing items related by title, author, creator and subject.
Liu, D.; Liu J; Wen, Z.; Li, Y.; Sun, Zhonghua; Xu, Q.; Fan, Z. (2017)Objective: To investigate the clinical value of renal perfusion imaging in patients with aortic dissection (AD) using 320-row computed tomography (CT), and to determine the relationship between renal CT perfusion imaging ...
Flow pattern analysis in type B aortic dissection patients after stent-grafting repair: Comparison between complete and incomplete false lumen thrombosisWan Ab Naim, W.; Ganesan, P.; Sun, Zhonghua; Lei, J.; Jansen, S.; Hashim, S.; Ho, T.; Lim, E. (2018)Endovascular stent graft repair has become a common treatment for complicated Stanford type B aortic dissection to restore true lumen flow and induce false lumen thrombosis. Using computational fluid dynamics, this study ...
The impact of the number of tears in patient-specific Stanford type B aortic dissecting aneurysm: CFD simulationNaim, Wan; Ganesan, Poo; Sun, Zhonghua; Osman, Kahar; Lim, Einly (2013)It is believed that the progression of Stanford type B aortic dissection is closely associated with vascular geometry and hemodynamic parameters. The hemodynamic differences owing to the presence of greater than two tears ...