Hypothesis: This study was undertaken to identify mechanisms of injury, dia
gnostic modalities, surgical management, and outcome in children with traum
atic aortic disruptions.
Design: Retrospective study.
Setting: University-affiliated private hospital.
Patients: All patients younger than 17 years listed in the trauma registry.
Intervention: Operative repair of thoracic aortic injuries.
Main Outcome Measures: There were 8 boys and 3 girls ranging in age from 12
to 17 years (mean, 14.8 years). Seven children were motor vehicle passenge
rs; 3 were pedestrians struck by vehicles; and 1 was thrown from a bull. Ao
rtic injuries were suspected on the basis of the mechanism of injury and ab
normal chest x-ray films (mediastinal widening). Aortic injuries were confi
rmed in 9 patients by arch aortography and in 2 patients by computed tomogr
aphy. The injuries involved the isthmus of the aorta in 9 patients (complet
e transections) and the aortic arch in 2 patients (avulsions of the great v
essels). Isthmus injuries were repaired by means of left heart bypass with
direct cannulation of the distal thoracic aorta in 8 patients and femoral v
enous to femoral arterial bypass in 1 patient. Arch injuries were repaired
during hypothermic circulatory arrest. The injured aortic segments were rep
laced with interposition grafts. There were no direct complications of anti
coagulation. Ten patients (91%) survived. The only death was caused by a se
vere closed head injury. There were no instances of paraplegia related to a
ortic repairs.
Conclusion: Good outcomes resulted from early diagnosis based on mechanism
of injury, prompt aortography, and computed tomography and operative manage
ment that included distal aortic perfusion with left heart bypass.