ABSTRACT
According to the literature, only a small proportion of occurrences regarding penetrating trauma of the thoracic aorta can be treated successfully. Herein we reported our experience of a recent rescue of such a patient in a countryside hospital lacking advanced instruments for cardiopulmonary bypass operations. A 20-year-old male was admitted for a penetrating injury with disrupted innominate vein and right common carotid artery together with a 1.5-cm laceration on the aortic arch between the innominate artery and the left common carotid artery. The patient was successfully saved without the implementation of cardiopulmonary bypass. Presentation and management in this case were discussed.
Subject(s)
Adult , Humans , Male , Aorta, Thoracic , Wounds and Injuries , General Surgery , Wounds, Penetrating , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To discuss our experience on the diagnosis and treatment of thoracic aorta rupture (TAR) that is one of the main common causes of death in the victims under blunt chest trauma.</p><p><b>METHODS</b>Between July 2001 and March 2006, 9 patients (6 men and 3 women, aged from 20 to 54 years) suffering from acute traumatic aorta rupture after motor vehicle accidents received emergent surgical treatments in our hospital. Based on our experience in the rescue of the first TAR patient we introduced a practical procedure on the diagnosis and treatment of TAR in our department. All the other patients generally followed this procedure. Eight patients received contrast material enhanced helical computerized tomography scan before the operation. The leakage of constrast medium from the aorta isthmus was found, and diagnosis of TAR was confirmed. Seven patients underwent immediate operation within 14 hours after accidents. One patient was treated on the 5th day of the accident because of delayed diagnosis of aortic rupture. All patients received general anesthesia with double lumen endotracheal tube and normothermic femoro-femoral partial cardiopulmonary bypass, with beating heart and aortic clamping. One patient received simple repair, and others received partial replacement of thoracic aorta with artificial vascular graft.</p><p><b>RESULTS</b>Seven TAR patients were successfully salvaged. Three patients combined brain injury as well as extremitiy hemiplegia before operation. After treatments one was fully and two partially recovered without paraplegia.</p><p><b>CONCLUSIONS</b>Proper practical protocol is emphasized for the surgical repair of TAR because it will reduce the mortality of severe blunt chest injury.</p>