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Traumatic aortic rupture: diagnosis and management

J S Gammie¹, A S Shah, B G Hattler

¹Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.

The Annals of Thoracic Surgery

|November 4, 1998

Summary

Aggressive medical management with beta-blockade and vasodilators is crucial for patients with traumatic aortic rupture. Partial left-heart bypass effectively prevents spinal cord ischemia during aortic repair surgery.

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Area of Science:

Cardiothoracic Surgery
Trauma Surgery
Vascular Surgery

Background:

Traumatic aortic rupture is a rare but challenging condition for cardiothoracic surgeons.
Diagnosis and management of traumatic aortic rupture present unique difficulties.

Purpose of the Study:

To review the experience with traumatic thoracic aortic ruptures.
To address controversial aspects of diagnosis and management.

Main Methods:

Retrospective chart review of 42 patients with traumatic thoracic aortic ruptures (1988-1997).

Main Results:

9 patients died in the emergency department due to lack of vital signs.
12% of initial chest radiographs were normal, causing diagnostic delays.

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26 patients underwent aortic repair, with 24 using partial left-heart bypass.

No new postoperative paraplegia occurred in the bypass group.

No morbidity was directly linked to heparin for cardiopulmonary bypass.

Conclusions:

Early aggressive medical treatment (beta-blockade, vasodilators) is essential for patients at risk of complete rupture.
Partial left-heart bypass is optimal for preventing spinal cord ischemia during acute traumatic aortic rupture repair.