Optimal timing of type A intramural hematoma repair
Autor: | Anthony L. Estrera, Akiko Tanaka, Zain Al Rstum, Steven B Eisenberg |
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Rok vydání: | 2019 |
Předmět: |
Keynote Lecture Series
medicine.medical_specialty genetic structures 030204 cardiovascular system & hematology Pathogenesis 03 medical and health sciences 0302 clinical medicine Hematoma Intramural hematoma Intravascular ultrasound Materials Chemistry medicine medicine.diagnostic_test business.industry medicine.disease Natural history Dissection medicine.anatomical_structure 030228 respiratory system Vasa vasorum cardiovascular system Surgery Radiology Presentation (obstetrics) Cardiology and Cardiovascular Medicine business |
Zdroj: | Annals of Cardiothoracic Surgery. 8:524-530 |
ISSN: | 2304-1021 2225-319X |
Popis: | Acute type A aortic intramural hematomas (IMHs) are often included under the spectrum of acute aortic syndromes. The classical definition is the presence of hematoma in the media without identifiable intimal tear. Dissection occurring within two weeks of presentation is defined as acute. Acute type A IMH remains a subject of debate, especially regarding its definition and management. The classical theory of pathogenesis of IMHs is ruptured vasa vasorum in the aortic media. However, the majority of IMHs are now detected with an intimal defect using high-resolution computed tomography and intravascular ultrasound, which implies that IMHs may be a subset of aortic dissections (ADs), with very limited flow in the false lumen. Much controversy remains regarding IMH differences in presentation, diagnosis, and risk for progression. Geographic location and ethnicity, especially Asian vs. Western, possibly affect the natural history and outcomes of acute type A IMH. In this review, we describe the pathophysiology and management strategies for acute type A IMHs. |
Databáze: | OpenAIRE |
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