Transesophageal echocardiography and therapeutic management of patients sustaining blunt aortic injuries.
BACKGROUND
No objective criteria have been described to help selecting patients with major blunt aortic injury (BAI) for postponed surgical repair. The efficacy of conservative management of minor BAI needs further evaluation.


METHODS
We studied 31 patients (Injury Severity Score, 48 +/- 15) who sustained a BAI diagnosed using transesophageal echocardiography (TEE). In patients with major BAI, the timing of surgery was made on the basis of clinical findings (grade 2) or TEE results (grade 3). We retrospectively separated patients into group I (rapid surgery, < or = 12 hours; n = 13) and group II (late or no surgery; n = 11). All major BAIs were confirmed by alternative imaging modalities or surgery. Patients with minor BAI (grade 1; n = 7) prospectively underwent conservative management with serial TEE follow-up.


RESULTS
All patients with grade 3 BAI (n = 4) were promptly operated on. No group II patient died as a result of aortic rupture, and all of them exhibited a small false aneurysm formation (ratio between the maximal diameter of the injured aortic isthmus and the diameter of the normal descending aorta < 1.4) and hemomediastinum (< 7.2 mm). TEE follow-up of group II patients (mean, 5 months) showed stable BAI, whereas follow-up of patients with minor BAI (mean, 15 months) disclosed total healing (n = 3) or stable lesions (n = 4).


CONCLUSIONS
Conservative management of minor BAI with serial follow-up appears to be appropriate. In patients with a grade 2 BAI and small false aneurysm formation and hemomediastinum, postponed surgical repair appears to be safe. However, these TEE criteria remain to be tested prospectively.
Vignon
Philippe
P
Intensive Care Unit, Dupuytren University Hospital, 87042 Limoges, France. vignon@unilim.fr
Martaillé
Jean-François
JF
François
Bruno
B
Rambaud
Geoffrey
G
Gastinne
Hervé
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001011:Aorta / Q000000981:diagnostic imaging* / Q000293:injuries*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery