Pediatric aortic disruption

Although trauma is the primary cause of death in children, few reports or series exist regarding the management of traumatic aortic disruption in the pediatric age group. The clinical outcome in children diagnosed with acute aortic disruption may be directly influenced by diagnostic and therapeutic management decisions. We reviewed the clinical course of 3 consecutive pediatric patients (mean age, 10.0 years; range, 4-16 years) admitted to our institution from January 2002 through May 2003 with the diagnosis of acute aortic disruption due to blunt trauma. In each case, the cause was a motor vehicle accident. Major, concomitant injuries involving other organ systems were present in each patient. Our operative goals were to use primary repair techniques, avoid the use of endovascular stent grafts, and use partial left heart bypass during aortic cross-clamping whenever possible. Each patient underwent successful operative repair. Aortic reconstruction techniques included primary suture repair in the 4-year-old patient, patch angioplasty in the 16-year-old, and placement of an interposition conduit in the 10-year-old for a blow-out type aortic injury. All patients received partial left heart bypass during aortic cross-clamping (mean, 36.6 min; range, 27-50 min), via a centrifugal pump, and anticoagulation. All patients recovered without evidence of adverse neurologic sequelae. Operative repair of acute aortic disruption in pediatric patients using circulatory support can provide good outcomes. Although not always feasible, the preferential use of primary aortic repair techniques in lieu of interposition conduits and endovascular aortic stents may decrease the potential for late pseudocoarctation.