Increased incidence of cardiac contusion in patients with traumatic thoracic aortic rupture.
A retrospective analysis of all patients with traumatic thoracic aortic rupture (TAR) admitted to the hospital over a consecutive 10-year period was performed in order to define the incidence, morbidity, and mortality of associated cardiac contusion (CC) in patients with TAR. Of the 13 patients with TAR, eight (62%) had associated CC. All patients with CC had two or more of the following positive findings: abnormal ECG, elevated myocardial-band creatinine kinase levels, abnormal radionuclide angiography/left ventricular segmental wall motion studies, or cardiac damage seen at surgery and postmortem examination. Four patients with TAR suffered cardiac arrest; all of the latter patients had associated CC. After successful repair of the TAR, five of six patients with combined TAR and CC developed adult respiratory distress syndrome (ARDS), whereas only one of five patients with isolated TAR had ARDS. All patients with isolated TAR survived, whereas three of eight patients suffering combined TAR and CC died perioperatively, secondary to cardiac arrest. In patients with TAR, the presence of associated CC occurs with increased frequency, is associated with increased morbidity (cardiac arrest, ARDS), and results in increased operative mortality secondary to cardiac instability. A branch-chain decision tree (clinical algorithm) was developed as a means of improving management of patients with combined TAR and CC, including indications for preoperative pulmonary artery catheterization.
Kram
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HB
Department of Surgery, King-Drew Medical Center, Los Angeles, CA 90059.
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Shoemaker
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries*; D001019:Aortic Rupture / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002140:California; D003288:Contusions / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006335:Heart Injuries / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications*