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내막파열을 동반하지 않은 대동맥 박리 ( 대동맥 벽내출혈 ) 에 대한 임상적 고찰
황경국(Kyung Kuk Hwang),박대균(Dae Gyun Park),연태진(Tae Jin Yeun),조영석(Young Seok Cho),손대원(Dae Won Sohn),김효수(Hyo Soo Kim),김철호(Cheol Ho Kim),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sh 대한내과학회 1998 대한내과학회지 Vol.54 No.1
N/A Objectives: This study was performed to verify the incidence and prognosis of aortic dissection without intimal tear (aortic intramural hemorrhage, IMH) who took only medical treatment in special referrence to Stanford type A. Methods: We analysed the patients of IMH confirmed by TEE, CT, MRI, angiography or CT-angiography in Seoul National University Hospital between 1987 and l9%, retrospectively. Results: The diagnosis of IMH was estabilished in 20 of 143 patients(14%). Nine patients were Stanford type A, 11 patients were type B. The longitudinal extent varied between 8 and 30cm, and IMH size varied between 10 and 3mm. Surgery was performed in two of type A patients because of persistent chest pain and one of type B patients because of progressive aortic dilatation despite of medical treatment. Follow-up imaging studies (mean follow-up period of 20.0±22.0 months) were done in 10/17 patients who were treated medicaliy. Complete resolution of IMH was observed in seven cases, four of them were Stanford type A, and the mean size of IMH was 12mm(10-17mm). Partial resolution was observed in one case, Stanford type A, with the IMH size of 15mm. There was no significant change in the size of IMH in two cases. Initial mean size of IMH was 25mm. In no case, aortic rupture or death was observed during the follow up period. Conclusion: In the management of the patient with MH, same surgical indications as classic aortic dissection have been advocated based on similar prognosis. However our study showed better prognosis in IMH patients treated medically compared to the previous publications. Therefore, even in cases of proximal IMH. medical treatment should be seriously considered.
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