RESUMO
BACKGROUND: Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. METHODS AND RESULTS: Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45+/-31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (P<0.02) and to longitudinal extension of IMH (P<0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH. CONCLUSIONS: The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.
Assuntos
Doenças da Aorta/diagnóstico , Hematoma/diagnóstico , Dissecção Aórtica/etiologia , Falso Aneurisma/etiologia , Aneurisma Aórtico/classificação , Aneurisma Aórtico/etiologia , Doenças da Aorta/complicações , Progressão da Doença , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Hematoma/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Remissão Espontânea , Tempo , Tomografia Computadorizada por Raios X , Grau de Desobstrução VascularRESUMO
A 40-year-old woman without heart disease suffered two embolic episodes in both legs due to a thrombus of the aortic valve. Transesophageal echocardiography performed after the first episode was considered normal, but a second study performed after the second embolism demonstrated a thrombus in the non-coronary leaflet that failed to resolve with the intravenous administration of heparin for two weeks. Surgical excision of the mass revealed a thrombus on an otherwise healthy aortic valve. The case is interesting because it is an exceptional cause of systemic embolism and the patient did not present a prothrombotic status in coagulation studies. The 3 years of follow-up was uneventful.
Assuntos
Valva Aórtica/patologia , Embolia/etiologia , Endocardite/etiologia , Doenças das Valvas Cardíacas/complicações , Trombose/etiologia , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Ecocardiografia Transesofagiana , Endocardite/patologia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do TratamentoAssuntos
Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico , Isquemia/complicações , Isquemia/diagnóstico , Perna (Membro)/irrigação sanguínea , Doença Aguda , Adulto , Idoso , Amputação Cirúrgica , Anticoagulantes/uso terapêutico , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/terapia , Arteriopatias Oclusivas/terapia , Aspirina/uso terapêutico , Clopidogrel , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Isquemia/terapia , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Espanha , Trombectomia , Trombose/complicações , Trombose/diagnóstico , Trombose/terapia , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Varfarina/uso terapêuticoRESUMO
In recent years, technological advances in echocardiography have led to improvements in the diagnosis of acute aortic disease. With transesophageal echocardiography (TEE) and, particularly, bi- and multiplane probes, the physiopathologic understanding of these diseases has widened. Thus, new entities such as penetrating ulcer and intramural hematoma have been described and differentiated from classical aortic dissection.