Diagnosis and Therapeutic Consequences of Intramural Aortic Hematoma

T. Schappert* (Corresponding Author), V. Sadony, F. Schoen, C. V. Birgelen, H. ‐R Zerkowski, R. Erbel

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    19 Citations (Scopus)

    Abstract

    The classical triad of sudden devastating chest pain, electrocardiographic absence of acute myocardial Infarction, and Identification of an upstream flap in the ascending aorta by transesophageal echocardlography (TEE) Indicates aortic type A dissection requiring emergent surgery. Among 34 patients presenting with clinical signs and symptoms of an aortic dissection, three did not show the mandatory flap in the upstream aorta. The only echocardlographic finding was aortic wall thickening Indicating an intramural hematoma. Two of these patients showed early aortic ectasia and one showed a pericardial effusion. Despite the missing flap echocardiographlcally, surgery was performed in all three patients. The surgical approach was the same as that for patients with a type A dissection. Two patients are doing well after the procedure, and one patient died after reoperation. The postoperatlve histologic work‐up confirmed that there was no intimal tear or dissection of the intimal layer. We conclude that the echocardiographic finding of an Intramural hematoma combined with typical clinical signs of chest pain, with myocardial infarction ruled out, requires emergent surgical intervention. (J Card Surg 1994;9:508–515)

    Original languageEnglish
    Pages (from-to)508-515
    Number of pages8
    JournalJournal of Cardiac Surgery
    Volume9
    Issue number5
    DOIs
    Publication statusPublished - Jul 1994

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