Surgical outcome of traumatic aortic disruption of the thoracic aorta in Songklanagarind Hospital.

ABSTRACT

This retrospective study collected data from 11 patients who underwent TDTA' repair from February 1987 to June 2003, 10 patients were men (90.9%) and 1 was a woman (9.09%) with a mean age of 32 years. All patients had a blunt injury from a violent motor vehicle accident. None of them required thoracotomy at the emergency room. Standard chest x-ray was done in every patient and the widening of the upper mediastinum was mainly found in 10 patients (90.9%), hemothorax in 8 patients, blurred aortic knob in 7 patients, lower left main bronchus in 3 patients, pleural apical cap in 2 patients and pneumothorax in 1 patient, 8 patients were investigated by CT scan and presented a positive study. 3 patients (27.27%) were diagnosed by both aortogram and CT scan anda pseudo-false aneurysm was found Multi organ system injury was mainly found in 10 patients (90.91%). 7 patients (63.64%) had hypovolumic shock on admission, 3 patients died postoperation and 2 of them had experience of postoperative paraplegia. Clamp and sew technique was used in 6 patients (54.54%). The duration of aortic cross clamp time ranged from 19-67 minutes (mean time = 39.30 min.) Pneumonia was the significant postoperative complication found in 3 patients, including acute renal failure, ARDS (all died) and paraplegia in 2 patients. The duration of the aortic cross clamp time that was used in the patients who presented with paraplegia was more than 40 minutes. 1 patient had delayed the aortic repair for 3 weeks resulting from severe brain contusion. 5 patients (45.45%) died in hospital. 1 patient died in the operating theatre, 4 of them (36.36%) died during postoperatively within 24 hours. The mainly cause of death which occurred in every patient was intraoperative cardiac arrest, the others were postoperative bleeding, ARDS and arrhythmias. The mean of length of stay in the intensive care unit was 6.94 days. The period of hospitalization ranged from 11 to 180 days (mean = 62.83 days). The small sample size is the limitation for the present study. The authors plan to do prospective study about the factors which influence the mortality rate and factors related to postoperative paraplegia in TDTA patients at Songklanakarind Hospital.