DIAGNOSTIC AND THERAPEUTIC LESSONS LEARNED FROM SURGICAL REPAIR OF 108 RUPTURES OF THE DESCENDING THORACIC AORTA

Traumatic rupture of the thoracic aorta should be suspected when autom obile (62.9%), motorcycle (11.1%), ski-doe (2.7%), deltaplane (0.9%), or skiing accidents (0.9%), cause a sudden and rapid deceleration. It was also encountered with a vertical fall of 10 meters and more (4.6%) , when a pedestrian was struck by a vehicle (4.6%) or the chest damage d by a high velocity flying object (4.6%). A lateral impact was found in 33% of injured patients and 52.7% were not wearing seat belts. Rupt ured aorta was found as a single lesion in only 12% of the cases and a mong associated orthopedic lesions (63.8%) and abdominal injuries (28. 7%), about 2/3 of them involved the left side of the body. The most re liable clinical sign of descending aortic rupture is the pseudo-coarct ation syndrome found in 53% in the acute phase by simple pulse palpati on and in 56% with blood pressure measurements. As soon as the diagnos is is suspected, associated hypertension present in 50% should be medi cally treated to avoid sudden exsanguination. Surgical repair should b e undertaken with a perfusion technique which is an integral part of t he ressuscitation procedure. A Gott shunt was used in 81 patients and a partial left heart bypass with a Bio-Medicus pump in 25 cases. This active atrio-aortic bypass is physiologically superior. The pump flow (3727 +/- 612 ml/min.) is superior to the shunt flow (2833 +/- 576 ml/ min.). Proximal pressure with the pump is better controlled (111 +/- 2 0 mmHg) than with the shunt (152 +/- 38 mmHg) and the mean distal pres sure obtained with the pump is higher (81 +/- 19 mmHg) than with the s hunt (64 +/- 22 mmHg). One case of paraplegia occured (0.9%) with an u nfunctionnal Gott shunt. The survival rate is 95.4% (63/66 cases) in t he acute phase and 100% (42/42 cases) in the chronic phase.