Original Articles
Traumatic aortic rupture: diagnosis and management

https://doi.org/10.1016/S0003-4975(98)00778-4Get rights and content

Abstract

Background. Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. To address controversial aspects of this disease, we reviewed our experience.

Methods. The study was performed by retrospective chart review.

Results. Forty-two patients with traumatic thoracic aortic ruptures were managed between January 1988 and June 1997. Nine arrived without vital signs and died in the emergency department. Admission chest radiographs were normal in 3 patients (12 %) and caused significant delays in diagnosis. Four of 30 patients admitted with vital signs had rupture before thoracotomy and died. Twenty-six underwent aortic repair. In 1 patient repair was performed with simple aortic cross-clamping, whereas a second was managed with a Gott shunt. The remaining 24 patients had repair with partial left heart bypass. In 1 patient hypothermic circulatory arrest was required. Two patients (7.7%) died. There were no cases of new postoperative paraplegia in the bypass group. There was no morbidity directly attributable to the administration of heparin for cardiopulmonary bypass.

Conclusions. In a discrete group of patients with traumatic rupture of the aorta, the rupture will become complete during the first few hours of hospital admission; aggressive medical treatment with β-blockade and vasodilators in the interval before the operation is an essential aspect of management. Active distal circulatory support with partial left-heart bypass provides the optimal means of preventing spinal cord ischemia during repair of acute traumatic aortic rupture.

Section snippets

Material and methods

Between January 1988 and June 1997 we treated 42 patients with blunt injuries to the thoracic aorta. There were 32 male and 10 female patients. Age ranged from 15 to 83 years, with a mean of 34 years. Three patients sustained falls, 1 patient was a pedestrian struck by a car, 1 patient was hit by a falling tree, and the remaining 37 patients were involved in motor vehicle crashes.

Means are reported with standard deviations. Comparison of continuous variables was with Student’s t test.

Results

Multiple injuries were the rule: injury severity scores ranged from 26 to 59, with a mean of 40 ± 9 (an injury severity score of 40 predicts a mortality of 41%). Nine patients arrived without vital signs. Eight of them underwent emergency thoracotomy in the emergency department and 1 had bilateral chest tubes placed; none survived. Families of 3 elderly patients with multiple injuries and substantial comorbidities declined operative intervention.

Four of 30 patients (13%) admitted with vital

Comment

This report details a recent clinical experience with traumatic rupture of the thoracic aorta. This is an uncommon injury: among an average of 1,600 blunt trauma admissions per year at our center during the study period, 4.4 TRAs were diagnosed and 3.2 were repaired. A recent survey of 50 trauma centers in North America documented an average of 2.2 cases of TRA per center per year [9]. The relatively infrequent occurrence of this entity means that few surgeons are able to accrue large personal

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