DELAYED SURGERY OF TRAUMATIC AORTIC RUPTURE - ROLE OF MAGNETIC-RESONANCE-IMAGING

Citation
R. Fattori et al., DELAYED SURGERY OF TRAUMATIC AORTIC RUPTURE - ROLE OF MAGNETIC-RESONANCE-IMAGING, Circulation, 94(11), 1996, pp. 2865-2870
Citations number
41
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
00097322
Volume
94
Issue
11
Year of publication
1996
Pages
2865 - 2870
Database
ISI
SICI code
0009-7322(1996)94:11<2865:DSOTAR>2.0.ZU;2-M
Abstract
Background Traumatic aortic rupture (TAR) is a pathological cal entity with a high mortality, both spontaneous and perioperative. Delayed su rgical repair has been proposed when associated lesions are stabilized . The aim of this study was to validate MRI for detecting both the pre sence and type of TAR and to monitor posttraumatic aneurysm and associ ated lesions. Methods and Results Twenty-four consecutive patients wit h acute chest trauma and suspected aortic rupture, as suggested by eme rgency CT or chest radiographs, were subjected to MRI and/or angiograp hy in random order. Such parameters as the presence and type of lesion ; presence of pericardial, pericardial, mediastinal, or pleural effusi on; and presence of associated lesions were considered in every patien t. Follow-up imaging was performed exclusively by MRI every 1 to 2 mon ths. TAR was present in 20 patients. No patient underwent surgery in t he acute phase; 14 patients underwent surgery at 6.8+/-2.7 months; 5 a re waiting for surgery; and 1 healed spontaneously. There was no overa ll mortality. For detection of TAR, the accuracy of MRI was 100%; angi ography, 84%; and CT, 69%. In detecting the type of lesion, the diagno stic accuracy of MRI was 92%. During follow-up, a significant increase in the posttraumatic aneurysm was observed in 2 patients, and surgica l repair was initiated. Conclusions In chest trauma patients, MRI prov ides complete anatomic data to assess the severity of aortic and thora cic lesions. Moreover, along with the concept of delayed surgical repa ir of TAR, MRI is the ideal modality to monitor and follow TAR before surgical repair.