Traumatic Rupture of Ascending Aorta and Left Main Bronchus

Sadow, Samuel H.; Murray, Charles; Wilson, Robert F.; Mansoori, Shahrokh; Harrington, Steven D.

doi:10.1016/s0003-4975(10)64780-7

Cited by 14 publications

(5 citation statements)

References 7 publications

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“…In the setting of blunt trauma, injury to the aortic valve, left main bronchus, or a coronary artery has been identified. [13][14][15] CABG has been performed in the setting of injury to one or more of the coronary arteries, but all of these patients required a bypass procedure for acute injuries. 15,16 In contrast, traumatic rupture of a normal aorta accompanied by CABG for a chronic disease process such as coronary artery disease does not appear to have been previously reported.…”

Section: Discussionmentioning

confidence: 99%

CABG for Chronic Disease During Repair of Traumatic Ascending Aortic Rupture

Hartwig

Biswas

Glower

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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T raumatic rupture of the thoracic aorta is a well-described phenomenon involving significant morbidity and mortality. Classically, this injury occurs at the aortic isthmus, where the aorta is tethered by ligamentous fibers. Although less common, several cases of ascending aortic rupture have been documented in the literature. Here we report a case of traumatic ascending aortic injury requiring emergent surgical repair. At the time of the procedure, the patient was noted to have severely calcified coronary arteries with evidence of previous myocardial damage and decreased ventricular function. Coronary artery bypass grafting (CABG) concomitant with placement of the aortic transposition graft was performed. CASE REPORTA 45-year-old Native American male lost control of his motorcycle at high speed and was ejected over 20 feet. He lost consciousness initially, but was taken to the local hospital where he was oriented on arrival and was noted to have an acetabular fracture and several rib fractures.He underwent intubation and fluid resuscitation and was airlifted to the regional level I trauma center for further evaluation. Vital signs on admission were a heart rate of 108 bpm and blood pressure of 135/81 mm Hg. AP portable CXR demonstrated right rib fractures, clavicle fracture, pulmonary contusion, enlarged cardiac silhouette, and a widened superior mediastinum (Fig. 1).CT scans of the head, abdomen, and pelvis were normal, except for a complex acetabular fracture. CT scan of the chest showed multiple displaced right rib fractures with a hemopneumothorax, pulmonary contusion, left scapula fracture, L 1 compression fracture, and a contour abnormality in the ascending aorta (Fig. 2) concerning for traumatic aortic injury. The descending aorta appeared intact. Arch aortogram demonstrated a 1 cm flap approximately 2 cm distal to the aortic valve consistent with traumatic aortic injury (Fig. 3).The patient underwent emergent repair of the aortic transection.Repair of the ascending aortic injury consisted of placing the patient on cardiopulmonary bypass (CPB) with cannulation of the aortic arch and the right atrium. The transection was identified approximately 1 cm distal to the left main

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Section: Discussionmentioning

confidence: 99%

CABG for Chronic Disease During Repair of Traumatic Ascending Aortic Rupture

Hartwig

Biswas

Glower

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…Also, as the causes of bronchial, aortic, and esophagus rupture are similar, we and others [5] suggest that patients with traumatic bronchial injury routinely undergo screening to exclude concomitant lesions of the aorta and esophagus, regardless of the presence or absence of specific symptomatology. Although median sternotomy has been advocated by some [4] in treating bronchial rupture and aortic disruption at the same time, we favored a posterolateral thoracotomy to repair the bronchial tract, as the lesions were complex and involved both the main bronchus and the upper and lower lobar bronchus. In our opinion, every attempt should be made to obtain primary reconstruction of the bronchial tree; in our case, this challenge was very difficult to achieve through sternotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Traffic accidents are the usual main cause of aortic (most often thoracic) injury [1] and tracheobronchial disruption [2]. The association of those two lesions has rarely been reported [3,4], although the initial mechanism explaining injury to the airways and thoracic great vessels is the same; combined deceleration, anterior chest compression, and high tracheal pressure are secondary to closed glottis. Here, we will report on a new case involving a patient with an asymptomatic aortic rupture and left bronchial disruption with special emphasis on the symptomatology and timing of the two repair operations.…”

Section: Introductionmentioning

confidence: 99%

Left Bronchial Disruption and Aortic Rupture after Blunt Chest Trauma

Baron

Galetta

Roussel

et al. 2001

Thorac cardiovasc Surg

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A 25-year-old male who had been involved in a traffic accident presented with a neurological disorder, bilateral pneumothoraces, and pneumomediastinum. Bronchoscopy revealed a complex rupture of the left bronchial tract. MRI revealed a sinus valsalva aneurysm. The bronchial lesion was first repaired via left thoracotomy. 10 days later, the aorta was repaired via sternotomy. In cases of combined bronchial and aortic lesion, a concomitant repair is not mandatory, at least when the aortic lesion appears limited and shows no signs of dissection.

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“…1 Injuries to the tracheobronchial tree are even rarer, with no good data on incidence. 2 Although this combination of injuries has been previously described in a 14-year-old adolescent male, 3 to our knowledge there are no reported cases in a younger child. We report a case of a 5-yearold male who suffered both of these rare injuries (traumatic aortic rupture and left mainstem bronchus transection due to blunt trauma).…”

mentioning

confidence: 82%