[HSF] intramural hematoma

[Giulio Rizzoli]

I disagree; the main purpose of the aortic dissection operation is to 
avoid the most common cause of death, which is intrapericardial 
rupture occurring within 1 month in 90% of the cases.
In many cases the intimal tear is located distally, below the 
sublavian artery and the dissection is retrograde ( in a recent case 
I did in a Japanese tourist, it was located at the diaphragmatic level).
In this case there wasn't any visible rupture at aortography (all the 
aorta was explored down to the abdomen!) nonetheless the aspect of 
the ascending aorta is exactly the same as in frank dissections. 
There is soft thrombus below the adventitia which infiltrates it and 
transudes on the aortopulmonary junction and in the pericardium were 
some blood was also recovered. I'm pretty sure this case would erode 
the adventitia and rupture within the pericardium.




At 14.16 04/10/2006, you wrote:
>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

Giulio Rizzoli MD FETCS
Cardiochirurgia Padova
tel. 049 821-2408
fax 049 821-2409
e-mail giulio.rizzoli at unipd.it