Traumatic rupture of thoracic aorta. Diagnosis and management
C. H. Dart Jr and H. E. Braitman
Of six cases of thoracic aortic rupture, four were acute and two were
chronic. In the four acute cases, suspicious findings were an appreciably
widened mediastinum, upper-extremity hypertension, change in pulse
amplitude, or, more hopefully, generalized hypertension, left
intraclavicular systolic murmur, and loss of posterior aortic shadow on
chest x-ray film. Preoperative angiography was essential. Three of four
acute aortic transections (one with aortic arch involvement) had
complicated associated injuries that necessitated delay in aortic surgical
repair; antihypertensive drugs, including propranolol hydrochloride, were
used for support in the interval. Perfusion by femoral vein-femoral artery
cardiopulmonary bypass was used. All four patients were operated on
successfully without residual complications. Two patients with chronic
conditions were recommended for surgery; one was successfully operated on,
using aorto-aortic bypass. Another patient, 27 years postinjury, refused
operation. Postoperative arteriograms were performed for baseline
observations of graft and suture-line characteristics in all cases.
