[HSF] intramural hematoma

[Ben Bidstrup]

IMHO, yes. This can be the basis of a dissection 
that extends. It can also embolize. I had one 
patient who presented with a white arm. CT and 
TEE showed thrombus in the arch. Warfarinized for 
6 months - no problems. Stopped warfarin and it 
recurred with a week, so I resected the arch 
between the LCC and subclavian. No more problems.

>Giulio, I had an identical case a couple of 
>years ago and did resection of the ascending 
>aorta just like for Type A dissection. 
>Afterwards I questioned my decision. The object 
>of treating Type A dissection is to remove the 
>part of the aorta which has the intimal tear. In 
>intramural hematoma there is no intimal tear. Is 
>it logical to resect part of the aorta in 
>absence of intimal tear or even a penetrating 
>ulcer? John Flege
>
>-----Original Message-----
>From: giulio.rizzoli at unipd.it
>To: OpenHeart-L at lists.hsforum.com
>Sent: Wed, 4 Oct 2006 4:50 AM
>Subject: [HSF] intramural hematoma
>
>    For those who doubt that an intramural hematoma is alike aortic dissection 
>  I want to show the images of the last case (78 
>y/o) I operated on with a modified Bentall. 
>27° , axillary artery and left carotid perfusion trough exposed arch. 
>  There was no trace of dissection at angio but a 
>very thickened aortic wall at CT scan. 
>  I show the appearance at pericardiectomy, 
>identical to that of a dissection and the clots 
>sandwich between media and adventitia. 
>   Giulio Rizzoli, Padova Italy 
>
>   Giulio Rizzoli MD FETCS 
>Cardiochirurgia Padova 
>tel. 049 821-2408 
>fax 049 821-2409 
>e-mail giulio.rizzoli at unipd.it 
>
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon