TRAUMATIC AORTIC RUPTURE - DIAGNOSIS AND MANAGEMENT

Background. Traumatic aortic rupture is a relatively uncommon lesion t hat presents the cardiothoracic surgeon with unique challenges in diag nosis and management. To address controversial aspects of this disease , we reviewed our experience. Methods. The study was performed by retr ospective chart review. Results. Forty-two patients with traumatic tho racic 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 cau sed significant delays in diagnosis. Four of 30 patients admitted with vital signs had rupture before thoracotomy and died. Twenty-six under went aortic repair. In 1 patient repair was performed with simple aort ic 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 b ypass group. There was no morbidity directly attributable to the admin istration of heparin for cardiopulmonary bypass. Conclusions. In a dis crete group of patients with traumatic rupture of the aorta, the ruptu re will become complete during the first few hours of hospital admissi on; aggressive medical treatment with P-blockade and vasodilators in t he interval before the operation is an essential aspect of management. Active distal circulatory support with partial left-heart bypass prov ides the optimal means of preventing spinal cord ischemia during repai r of acute traumatic aortic rupture. (Ann Thorac Surg 1998;66:1295-300 ) (C) 1998 by The Society of Thoracic Surgeons