AORTIC INTRAMURAL HEMORRHAGE VISUALIZED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY - FINDINGS AND PROGNOSTIC IMPLICATIONS

Objectives. This study describes the transesophageal echocardiographic and follow-up findings in patients with aortic intramural hemorrhage. Background. Localized aortic intramural hemorrhage resulting in layer ed thickening of the aortic wall seems to represent a variant of acute aortic dissection without communication or a typical moving intimal f lap. In autopsy studies this variant, attributed to a rupture of the v asa vasorum, has been described in 5% to 10% of patients with dissecti on. Methods. In a prospective transesophageal echocardiographic study in patients with aortic dissection performed between 1986 and 1991, th e diagnosis of intramural hemorrhage was established in 15 of 114 pati ents and either confirmed anatomically (7 patients) with an additional diagnostic imaging technique or on the basis of clear follow-up chang es (8 patients). Results. Elderly patients (mean age 70 years) with a history of hypertension were affected by this variant of dissection. T he ascending aorta was involved in 3 patients and the descending aorta in 12. The longitudinal extent varied between 3 and 20 cm, and wall t hickness varied between 0.7 and 3 cm. Classic aortic dissection develo ped in five patients (33%) and rupture in four (27%). Regression of ao rtic wall thickening was noted in two patients, whereas three patients became asymptomatic without apparent wall changes (33%). Surgery was performed in 5 patients, whereas medical therapy was continued in 10. During a mean follow-up period of 11 months, eight patients (53%) died because of complications of the aortic disease. Conclusions. Intramur al hemorrhage represents a variant of aortic dissection and may be an early finding in patients who develop classic aortic dissection or rup ture. Transesophageal echocardiography is an excellent method for the detection of intramural hemorrhage and for monitoring these patients.