Traumatic rupture of the thoracic aorta.

During the years 1961-78, 17 patients with traumatic rupture of the aorta underwent surgery at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Nine of the cases were acute ruptures and 8 were chronic aneurysms. All cases were confirmed by pre-operative aortography. Rupture was located in each case in the proximal descending thoracic aorta just distal to the left subclavian artery. Surgical repair was made by using a left-side bypass in all cases but one, in which the operation time was so short that no organ protection was needed. The absence of paraplegias and kidney lesions demonstrated the adequacy of organ protection. Two of the three operative deaths were probably related to the systemic heparinization during left-side bypass which, by causing exacerbation of the cerebral bleeding, could have led to death. The possibility that these two deaths could have been avoided by using the new heparin-bonded, non-thrombogenic shunts, which obviate the need for generalized heparinization, is discussed. Operation is also recommended in chronic cases and should be performed as soon as an aneurysm has been diagnosed.