Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 3-4, Pages: 196-199
https://doi.org/10.2298/SARH1604196S
Full text ( 285 KB)
Surgical treatment of intramural hematoma of the ascending aorta
Šušak Stamenko (Faculty of Medicine, Novi Sad + Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Redžek Aleksandar (Faculty of Medicine, Novi Sad + Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Torbica Vladimir (Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Rajić Jovan (Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Todić Mirko (Clinic for Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Introduction. Intramural hematoma of the aorta presents potentially fatal
condition developing as a result of a vasa vasorum rupture. It is a major
risk factor for developing a frank aortic dissection. Case Outline. A
65-year-old woman was admitted to our clinic for the second time, after her
symptoms of chest pain and vertigo (with no electrocardiographic signs of
myocardial infarction) hadn’t disappeared after several months of medicament
treatment (indicated in the first hospitalization). Computed tomography
arteriography of the aorta showed no sign of acute aortic dissection, but
revealed a contrast depo in the aortic wall of 8 Ч 14 mm dimensions, with no
extravasation of contrast. Also, massive pericardial effusion was observed
(10-30 mm in thickness). Transesophageal echocardiography confirmed these
findings completely. The patient underwent surgery, in which plaque
exulceration was detected on the convex side of the ascending aorta, 3 cm
above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A
resection of the ascending aorta was performed, and the aorta was
reconstructed with a 30 mm Dacron tube graft. The patient was discharged on
the 14th postoperative day with satisfactory results. Conclusion. Intramural
hematoma is not a common event, but it is potentially a fatal one. Open
surgery in patients with an intramural hematoma is an effective treatment
strategy, although percutaneous endovascular treatment options are being
described.
Keywords: ascending aorta, aortic dissection, intramural hematoma, cardiovascular surgical procedures