초록접수 현황
| 20F-086 | 구연 발표 |
High versus Low Thoracic Aorta Calcium score in Acute type A Intramural Hematoma
Ha Lee¹, Myeong su Kim¹, Wan Kee Kim², Seungjun Song², Tae-Hoon Kim¹, Suk-Won Song¹, Kyung-Jong Yoo³
¹ Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
² Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
³ Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : Acute type A intramural hematoma(ATAIMH) is related to atherosclerosis. Classifying ATAIMH into antegrade and retrograde type, Thoracic Aorta Calcium(TAC) score will help understand the pathophysiology and customized treatments of ATAIMH.
Methods : Retrospectively 47 patients with ATAIMH with surgery(2008 to 2018) were analyzed. Antegrade ATAIMH(n=17) had successful tear-oriented surgery defined as identification and elimination of tear at the operation. Retrograde ATAIMH(n=30) had failure of tear-oriented surgery defined as unidentified or remnant tears at the operation. Postoperative follow-up CTs were analyzed for newly developed penetrating aortic ulcer(PAU)s or growing remnant tears. Additional endovascular treatments in patients who had newly developed or growing remnant tear/PAUs were reviewed. All patients’ TAC score was calculated reviewing preoperative non-enhanced CTs and using Agatston scoring system.
Results : Antegrade ATAIMH(A, n=17) had no additional endovascular treatments. Retrograde ATAIMH with stable Aorta(no newly developed and no growing remnant tear/PAUs at follow-up CTs)(B, n=11) also had no additional endovascular treatments. Retrograde ATAIMH with unstable Aorta(newly developed or growing remnant tear/PAUs at follow-up CTs)(C, n=19) had additional endovascular treatments in 9 patients. All of them underwent Thoracic Endovascular Aortic Repair (TEVAR) due to the growing of descending thoracic aorta PAU or aneurysm. Group A TAC score(4186.29) was higher than group B TAC score(1876.64, P=.022) and group C TAC score(1575.84, P=.010).
Conclusion : High TAC provides rigidity to intima preventing the intimal flap formation in antegrade ATAIMH. Not requiring high TAC, the low retrograde flow itself is the cause of retrograde ATAIMH. Antegrade ATAIMH needs emergency surgery, while retrograde ATAIMH needs thorough follow-up.
Methods : Retrospectively 47 patients with ATAIMH with surgery(2008 to 2018) were analyzed. Antegrade ATAIMH(n=17) had successful tear-oriented surgery defined as identification and elimination of tear at the operation. Retrograde ATAIMH(n=30) had failure of tear-oriented surgery defined as unidentified or remnant tears at the operation. Postoperative follow-up CTs were analyzed for newly developed penetrating aortic ulcer(PAU)s or growing remnant tears. Additional endovascular treatments in patients who had newly developed or growing remnant tear/PAUs were reviewed. All patients’ TAC score was calculated reviewing preoperative non-enhanced CTs and using Agatston scoring system.
Results : Antegrade ATAIMH(A, n=17) had no additional endovascular treatments. Retrograde ATAIMH with stable Aorta(no newly developed and no growing remnant tear/PAUs at follow-up CTs)(B, n=11) also had no additional endovascular treatments. Retrograde ATAIMH with unstable Aorta(newly developed or growing remnant tear/PAUs at follow-up CTs)(C, n=19) had additional endovascular treatments in 9 patients. All of them underwent Thoracic Endovascular Aortic Repair (TEVAR) due to the growing of descending thoracic aorta PAU or aneurysm. Group A TAC score(4186.29) was higher than group B TAC score(1876.64, P=.022) and group C TAC score(1575.84, P=.010).
Conclusion : High TAC provides rigidity to intima preventing the intimal flap formation in antegrade ATAIMH. Not requiring high TAC, the low retrograde flow itself is the cause of retrograde ATAIMH. Antegrade ATAIMH needs emergency surgery, while retrograde ATAIMH needs thorough follow-up.
첨부파일 : Table and Figure_Ha Lee.docx
책임저자: Suk-Won Song
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Ha Lee, E-mail : manofwill@yuhs.ac