[Diagnostic and therapeutic observations drawn from the surgical experiences of 108 traumatic ruptures of the descending thoracic aorta].
Traumatic rupture of the thoracic aorta should be suspected when automobile (62.9%), motorcycle (11.1%), ski-doo (2.7%), deltaplane (0.9%), or skiing accidents (0.9%), cause a sudden and rapid deceleration. It was also encountered with a vertical fall of 10 meters and more (4.6%), when a pedestrian was struck by a vehicle (4.6%) or the chest damaged by a high velocity flying object (4.6%). A lateral impact was found in 33% of injured patients and 52.7% were not wearing seat belts. Ruptured aorta was found as a single lesion in only 12% of the cases and among associated orthopedic lesions (63.8%) and abdominal injuries (28.7%), about 2/3 of them involved the left side of the body. The most reliable clinical sign of descending aortic rupture is the pseudo-coarctation syndrome found in 53% in the acute phase by simple pulse palpation and in 56% with blood pressure measurements. As soon as the diagnosis is suspected, associated hypertension present in 50% should be medically treated to avoid sudden exsanguination. Surgical repair should be undertaken with a perfusion technique which is an integral part of the ressuscitation procedure. A Gott shunt was used in 81 patients and a partial left heart bypass with a Bio-Medicus pump in 25 cases. This active atrioaortic bypass is physiologically superior. The pump flow (3727 +/- 612 ml/min.) is superior to the shunt flow (2833 +/- 576 ml/min.). Proximal pressure with the pump is better controlled (111 +/- 20 mmHg) than with the shunt (152 +/- 30 mmHg) and the mean distal pressure obtained with the pump is higher (81 +/- 19 mmHg) than with the shunt (64 +/- 22 mmHg). One case of paraplegia occured (0.9%) with an unfunctionnal Gott shunt. The survival rate is 95.4% (63/66 cases) in the acute phase and 100% (42/42 cases) in the chronic phase.
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Service de Chirurgie Vasculaire, Hôpital du Sacré-Caeur de Montréal, Québec, Canada.
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Blair
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D000058:Accidental Falls; D000063:Accidents, Traffic; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001794:Blood Pressure; D002908:Chronic Disease; D005260:Female; D018611:Heart Bypass, Left / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010173:Palpation; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D011674:Pulse; D011859:Radiography; D012865:Skiing / Q000293:injuries; D015996:Survival Rate; D013898:Thoracic Injuries / Q000150:complications
Observations diagnostiques et thérapeutiques tirées d'une expérience chirurgicale de 108 ruptures traumatiques de l'aorte thoracique descendante.