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Surgical experience with traumatic rupture of the thoracic aorta
1Third Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Insights
Contrast-enhanced CT effectively diagnoses traumatic thoracic aortic rupture (TAR), reducing the need for aortography. This imaging technique aids in early detection and guides emergency surgical interventions for TAR patients.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Trauma Surgery
Background:
- Traumatic thoracic aortic rupture (TAR) is a life-threatening injury.
- Early and accurate diagnosis is critical for patient survival.
- Conventional diagnostic methods can be invasive or time-consuming.
Purpose of the Study:
- To evaluate the diagnostic utility of contrast-enhanced computed tomography (CT) in identifying traumatic thoracic aortic rupture (TAR).
- To assess the role of CT in selecting patients requiring aortography for suspected TAR.
- To review surgical management and outcomes for TAR patients.
Main Methods:
- Retrospective review of nine surgically treated traumatic thoracic aortic rupture (TAR) cases.
- Analysis of contrast-enhanced CT findings in suspected TAR patients.
- Comparison of CT results with aortography and surgical findings.
Main Results:
- Contrast-enhanced CT accurately identified mediastinal hematoma, a key indicator of TAR.
- CT obviated the need for aortography in 38.5% of suspected TAR cases.
- Three patients with clear CT signs of rupture underwent surgery without prior aortography.
- Heparinless left heart bypass with BioPump showed promise for spinal cord protection during TAR repair.
Conclusions:
- Contrast-enhanced CT is a reliable tool for early diagnosis and patient selection for aortography in traumatic thoracic aortic rupture (TAR).
- CT facilitates timely emergency surgical intervention for TAR.
- The BioPump may be a valuable adjunct for spinal cord protection in TAR repair.
Abstract:
Nine cases of traumatic thoracic aortic rupture (TAR), operated on at St. Marianna University Hospital between July 1980 and December 1988, were reviewed in order to evaluate the role of contrast-enhanced CT in the early diagnosis of TAR. The absence of mediastinal hematoma on CT eliminated the need for aortography in 30 (38.5%) of the 78 patients suspected of having TAR on the basis of chest roentgenograms. The presence of mediastinal hematoma necessitated aortography in 48 patients. However, operative treatment was carried out without aortography in 3 patients who had specific signs of rupture on CT. CT proved to be a reliable indicator for the selection of the patients who need aortography. As a rule, emergency operations were performed in these patients. Simple aortic crossclamping was employed in 4 patients, and heparinless left heart bypass with the BioPump was performed for spinal cord protection in 2 recent patients without complication of embolization. Use of the BioPump as an adjunct in the repair of TAR appears to be promising.