[Unusual traumatic rupture of the thoracic aorta with avulsion of the left subclavian artery].

Of the many cases of traumatic rupture of the aorta diagnosed each year at l"Hôpital du Sacré-Coeur, Montreal, most patients are already in irreversible shock when seen. However, during the period Oct. 1, 1974 to Sept. 30, 1975, prompt surgical treatment saved six patients. One of these six patients had a complete trans-section of the aortic arch between the left carotid and left subclavian arteries with avulsion and slight retraction of the left subclavian artery. Repair of the aortic arch and left subclavian artery was accomplished without extracorporeal circulation. A sutureless temporary bypass shunt was created by (a) cannulating the ascending and descending aorta, the cannulas being secured with purse-string sutures and joined by a 3/8-inch (94-mm) polyvinyl chloride (PVC) tube connected to a "double T" adapter, and (b) joining two small PVC tubes from the adapter with two straight cannulas, a no. 14 being inserted into the innominate artery and a no. 12 being inserted into the left carotid artery. With this temporary bypass created, the ascending and descending aorta and aortic arch vessels were all clamped. Aortic continuity was re-established with a tubular Dacron graft (diameter, 19 mm) to which was anastomosed a side-arm of knitted Dacron (diameter, 10 mm) to repair the left subclavian artery. Throughout the temporary perfusion the brain, spinal cord and all abdominal viscera were well protected. No sign of ventricular distension was detected. This report is the first in which complete transsection of the aortic arch has been managed by a sutureless bypass shunt allowing perfusion of all aortic arch vessels without extracorporeal circulation.