Author + information
- Jae-Kwan Song, MD, FACCa ()
We appreciate the comments of Tittle et al. regarding our recent publication (1). We agree that we are not yet ready to answer the question as to how the natural history of intramural hematoma differs from that of classic dissection. Tittle et al. described the results of “midterm follow-up” of their patients, and they concluded that operative intervention is justified due to high rates of mortality and vascular complications of this “virulent” lesion. We accept their idea that we need longer follow-up duration to derive a meaningful conclusion about that question. However, we would like to remind them that we are not the only investigators who have some concerns about the strategy that all patients with proximal aortic intramural hematoma need urgent surgical repair (2–4). Tittle et al. reported a very high rate of delayed rupture in these patients, which is a very unusual finding based on our limited experience. We wonder whether any imaging study was done regularly to check the development of potential complications or whether they found any abnormal finding predicting the event. Because useful noninvasive diagnostic tools for aortic pathology are available today, serial follow-up imaging studies with longer duration are feasible and would provide the final answer to these questions.
Finally, we would like to remind other readers that our recent report was a retrospective analysis of data obtained in a single center, and our data are not so complete as to support when it is appropriate to operate on those patients with proximal aortic intramural hematoma. We hope our study will stimulate many groups to reevaluate the natural history of proximal intramural hematoma and perhaps to examine the same question in non-Asian populations.
- American College of Cardiology