title: Traumatic aortic rupture: diagnosis and management.
abstract: BACKGROUND
  Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. To address controversial aspects of this disease, we reviewed our experience.
  
  
  METHODS
  The study was performed by retrospective chart review.
  
  
  RESULTS
  Forty-two patients with traumatic thoracic aortic ruptures were managed between January 1988 and June 1997. Nine arrived without vital signs and died in the emergency department. Admission chest radiographs were normal in 3 patients (12%) and caused significant delays in diagnosis. Four of 30 patients admitted with vital signs had rupture before thoracotomy and died. Twenty-six underwent aortic repair. In 1 patient repair was performed with simple aortic cross-clamping, whereas a second was managed with a Gott shunt. The remaining 24 patients had repair with partial left heart bypass. In 1 patient hypothermic circulatory arrest was required. Two patients (7.7%) died. There were no cases of new postoperative paraplegia in the bypass group. There was no morbidity directly attributable to the administration of heparin for cardiopulmonary bypass.
  
  
  CONCLUSIONS
  In a discrete group of patients with traumatic rupture of the aorta, the rupture will become complete during the first few hours of hospital admission; aggressive medical treatment with beta-blockade and vasodilators in the interval before the operation is an essential aspect of management. Active distal circulatory support with partial left-heart bypass provides the optimal means of preventing spinal cord ischemia during repair of acute traumatic aortic rupture.
authors.affiliation: Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Gammie
authors.forename: A S
authors.initials: AS
authors.lastname: Shah
authors.forename: B G
authors.initials: BG
authors.lastname: Hattler
authors.forename: R L
authors.initials: RL
authors.lastname: Kormos
authors.forename: A B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: B P
authors.initials: BP
authors.lastname: Griffith
authors.forename: S M
authors.initials: SM
authors.lastname: Pham
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries; D001019:Aortic Rupture / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D018611:Heart Bypass, Left; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery*