This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (7)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pediatric Surgery  • Alert me on articles by topic

David Hormuth, MD; Dominic Cefali, MD; Thomas Rouse, MD; John Cutshaw, RN; William Turner, Jr, MD; George Rodman, Jr, MD

Arch Surg. 1999;134:759-763.

Hypothesis  This study was undertaken to identify mechanisms of injury, diagnostic modalities, surgical management, and outcome in children with traumatic aortic disruptions.

Design  Retrospective study.

Setting  University-affiliated private hospital.

Patients  All patients younger than 17 years listed in the trauma registry.

Intervention  Operative repair of thoracic aortic injuries.

Main Outcome Measures  There were 8 boys and 3 girls ranging in age from 12 to 17 years (mean, 14.8 years). Seven children were motor vehicle passengers; 3 were pedestrians struck by vehicles; and 1 was thrown from a bull. Aortic injuries were suspected on the basis of the mechanism of injury and abnormal chest x-ray films (mediastinal widening). Aortic injuries were confirmed in 9 patients by arch aortography and in 2 patients by computed tomography. The injuries involved the isthmus of the aorta in 9 patients (complete transections) and the aortic arch in 2 patients (avulsions of the great vessels). Isthmus injuries were repaired by means of left heart bypass with direct cannulation of the distal thoracic aorta in 8 patients and femoral venous to femoral arterial bypass in 1 patient. Arch injuries were repaired during hypothermic circulatory arrest. The injured aortic segments were replaced with interposition grafts. There were no direct complications of anticoagulation. Ten patients (91%) survived. The only death was caused by a severe closed head injury. There were no instances of paraplegia related to aortic repairs.

Conclusion  Good outcomes resulted from early diagnosis based on mechanism of injury, prompt aortography, and computed tomography and operative management that included distal aortic perfusion with left heart bypass.

From the Sections of Cardiothoracic Surgery (Drs Hormuth and Cefali and Mr Cutshaw), Pediatric Surgery (Dr Rouse), and Trauma Surgery (Drs Turner and Rodman), Clarian Methodist Hospital, Indianapolis, Ind.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Management of traumatic rupture of the thoracic aorta in pediatric patients
Karmy-Jones et al.
Ann. Thorac. Surg. 2003;75:1513-1517.
ABSTRACT | FULL TEXT