Therapeutic Strategy of Acute Aortic Intramural Hematoma

The limited data on the natural history of intramural hematoma (IMH) suggest that it behaves very much like classic aortic dissection (AD) and should therefore be treated in a similar fashion. However, there is considerable controversy surrounding its prognosis and treatment. In order to investigate long-term clinical course in patients with IMH, we compared clinical data between type A IMH and AD patients and between type B IMH and AD patients. All type A IMH patients were treated initially with supportive medical therapy. All type B IMH or AD patients were treated with medical therapy. The actuarial survival rate in type A IMH patients was significantly higher than type A AD patients. The incidence of aortic regurgitation and stroke were significantly lower in IMH patients. On the other hand, the actuarial survival rate in type B IMH patients was significantly higher than type B AD patients. In summary, patients with IMH have different clinical features and better long-term prognosis than patients with AD. Considering mortality and morbidity for surgical repair, supportive medical treatment with frequent follow-up imaging studies can be a rational therapeutic strategy for type A MR Patients with type B IMH have favorable outcome with medical therapy.