Prêtre R, LaHarpe R, Cheretakis A, Kürsteiner K, Khatchatourian G, Didier D, Faidutti B
Department of Surgery, University Hospital, Geneva, Switzerland.
Surgery. 1996 Jun;119(6):603-10. doi: 10.1016/s0039-6060(96)80183-8.
Injury to the ascending aorta is a rare lesion that may present in various forms. A thorough analysis of this lesion is lacking in the literature. This study was undertaken to delineate the prevalence and modes of presentation of injuries to the ascending aorta after blunt trauma and to suggest guidelines for management.
A retrospective analysis of autopsies performed in our department of forensic medicine on blunt trauma victims from 1984 to 1993 and a literature review of autopsy series were undertaken to delineate the prevalence and relevant characteristics of this injury. A cash report from our institution and a review of the literature were used to provide information regarding clinical presentations of this injury and treatment approaches.
Three modes of presentation were encountered. (1) Presentation at autopsy: The prevalence of injury to the ascending aorta after a traffic accident was 2% in our autopsy series. Among 13 patients with this injury 12 had other associated, potentially lethal lesions. A massive hemopericardium was present in two patients only. In autopsy series the incidence of injury to the ascending aorta in patients with an injury to the aorta ranged from 0% to 23%. (2) CLINICAL PRESENTATION: Twenty-one patients were treated surgically and reported in the literature. Fourteen presented with a pseudoaneurysm and seven with a chronic sinus of Valsalva fistula. One patient with a pseudoaneurysm presented with signs of cardiac tamponade and required immediate decompression; the others were hemodynamically stable. Seven patients had a cardiac lesion (valve tear in six and cardiac contusion in one), and three had an arch vessel lesion. Aorta repair was performed under cardiopulmonary bypass in every patient. (3) Incidental presentation: Seven patients with a traumatic tear of the aortic valve presented an incidental lesion of the ascending aorta. It was a subadventitial hematoma in three patients and an intimal and medial tear in four patients. Aortic tears were reinforced by direct suture.
Injury to the ascending aorta after blunt trauma is rare but lethal mostly from associated injuries. Survivors may appear in stable condition and present mostly with pseudoaneurysms of the ascending aorta or sinus of Valsalva fistula. Associated lesions to the heart and arch vessels should be looked for. Repair of the ascending aorta injury is performed under cardiopulmonary bypass.
升主动脉损伤是一种罕见的病变，可能有多种表现形式。文献中缺乏对该病变的全面分析。本研究旨在明确钝性创伤后升主动脉损伤的发生率和表现方式，并提出处理指南。
对1984年至1993年在我们法医学系对钝性创伤受害者进行的尸检进行回顾性分析，并对尸检系列进行文献综述，以明确该损伤的发生率和相关特征。利用我们机构的一份病例报告和文献综述来提供有关该损伤临床表现和治疗方法的信息。
发现了三种表现方式。（1）尸检时发现：在我们的尸检系列中，交通事故后升主动脉损伤的发生率为2%。在13例有此损伤的患者中，12例有其他相关的、可能致命的病变。仅2例患者有大量心包积血。在尸检系列中，主动脉损伤患者中升主动脉损伤的发生率为0%至23%。（2）临床表现：文献报道有21例患者接受了手术治疗。14例表现为假性动脉瘤，7例表现为慢性主动脉瓣窦瘘。1例假性动脉瘤患者出现心脏压塞体征，需要立即减压；其他患者血流动力学稳定。7例患者有心脏病变（6例为瓣膜撕裂，1例为心脏挫伤），3例有弓部血管病变。所有患者均在体外循环下进行主动脉修复。（3）偶然发现：7例主动脉瓣外伤性撕裂患者偶然发现升主动脉病变。3例为外膜下血肿，4例为内膜和中膜撕裂。主动脉撕裂通过直接缝合加强。
钝性创伤后升主动脉损伤虽罕见，但大多因合并伤而致命。幸存者可能病情稳定，主要表现为升主动脉假性动脉瘤或主动脉瓣窦瘘。应寻找心脏和弓部血管的相关病变。升主动脉损伤的修复在体外循环下进行。
