Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma. Therapeutic implications.

Aims: Intramural haematoma (IMH) forms part of the acute aortic syndrome presenting physiopathologic and evolutive patterns different from those of aortic dissection. The aim of this study was to determine the mortality and predictive factors of IMH in the first 3 months of evolution.

Methods And Results: Sixty-eight consecutive patients diagnosed of IMH (12 type A, 56 type B) were prospectively studied. Ten patients (eight type A, two type B) were surgically treated for clinical or haemodynamic evolution. Mortality rate was 19% (six type A and seven type B): five surgically treated (three type A, two type B) and eight medically treated (three type A, five type B). No relationship was observed between clinical variables and evolution. Maximum aortic diameter was greater in the group of patients who died (65.5+/-14.4 mm vs 46.0+/-7.6 mm; P<0.0001). Mortality rate in patients with aortic diameter >50 mm was 50% (P<0.0001). Significant periaortic bleeding was mortality-related (47%; P<0.005). Multivariate analysis showed only a significant relationship between mortality and maximum aortic diameter >50 mm (OR=11.33; P<0.005) and ascending aorta involvement (OR=11.18; P<0.05).

Conclusion: Intramural haematoma mortality in the first 3 months of evolution is high (19%). Maximum aortic diameter >50 mm and ascending aorta involvement are predictive of early mortality.