Traumatic rupture of the thoracic aorta.

The experience in the surgical treatment of traumatic rupture of the thoracic aorta is discussed. Twenty-two patients were seen from 1970 to 1980. They were divided into three groups, according to delay between injury and aortic repair: 1 degree emergency group: 16 patients; 2 degree delayed group: 3 patients; 3 degrees chronic group: 3 patients. All patients had a widened mediastinum and the aortography confirmed the diagnosis. In the first group four patients died before surgery could be started and four after aortic repair from 10 days to 6 seeks postoperatively. In the second and third group all patients survived. Of 22 cases, 21 ruptures were located at the aortic isthmus and 1 at the aortic arch. Many patients had various other injuries, skeletal, abdominal or cerebral. All, but one patient, were operated with the aid of a partial pulsatile left heart bypass to avoid cerebral hypertension and cardiac overload, and to prevent kidney and spinal cord ischemia. One patient was operated, according to the method of Crawford, with blood pressure controlled with nitroprusside. We have not observed in our patients paresis or paraplegia after surgery. The hospital mortality of the surgical treated patients was 34% in the emergency group and 0% in the delayed and chronic group. Surgical treatment is essential in emergency situation, as a complete rupture may be fatal and repair of the chronic post-traumatic false aneurysm is advocated, as their prognosis is unpredictable.