title: Challenges in the diagnosis and management of unusual presentations of blunt injury to the ascending aorta and aortic sinuses.
abstract: BACKGROUND
  Blunt injury to the thoracic aorta continues to carry significant mortality and the diagnostic algorithms are evolving as new technology is developed. With improved pre-hospital care, patients with unusual blunt injuries to the aorta may survive to evaluation. While current algorithms for screening focus on the more common blunt injuries to the descending thoracic aorta, our service has seen four injuries to the ascending aorta that have had unusual presentations and presented significant challenges in their management.
  
  
  METHODS
  Retrospective chart review based on a cardiovascular injury database.
  
  
  RESULTS
  Four patients were identified who survived to hospitalization with an injury to the ascending thoracic aorta. Two were to the ascending aorta and two to the aortic sinuses. Two presented with closed head injury complicating management. One patient presented with aortic valve insufficiency. Motion artifacts at the aortic sinus made screening by CT challenging. These injuries were managed with primary repair (1), tube graft replacement (2), and aortic root replacement with reimplantation of the coronaries (1), all with cardiopulmonary bypass.
  
  
  CONCLUSIONS
  Injuries to the ascending aorta and aortic sinus that survive to evaluation present unique challenges to the screening algorithms. All required cardiopulmonary bypass for repair and potentially complex reconstructions with management decisions affected by the presence of associated injuries. New methodologies such as CT scan gated to cardiac motion may offer higher resolution in this area.
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. mwall@bcm.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Peter I
authors.initials: PI
authors.lastname: Tsai
authors.forename: Ramyar
authors.initials: R
authors.lastname: Gilani
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
mesh_terms: D000063:Accidents, Traffic; D000465:Algorithms; D001013:Aorta, Thoracic / Q000293:injuries*; D002315:Cardiopulmonary Bypass / Q000379:methods; D006259:Craniocerebral Trauma / Q000150:complications; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*