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J Thorac Cardiovasc Surg 2008;135:428-430
© 2008 The American Association for Thoracic Surgery

Brief Communication

Delayed surgery for traumatic rupture of aortic arch with dissection of the left anterior descending artery

John EV, MCh, DNBa,*, Gopalakrishnan Mundayat, MCha, Kodhandapani Chunduru, MCha, Jacob Abraham, MDb, Aruna Palliyil, MDb, Das Perimpa, DPTc

a Department of Cardiac Surgery, Medical Trust Hospital, Kochi, Kerala, India
b Department of Cardiac Anaesthesia, Medical Trust Hospital, Kochi, Kerala, India
c Department of Cardiac Perfusion, Medical Trust Hospital, Kochi, Kerala, India

Received for publication August 24, 2007; accepted for publication September 24, 2007.

* Address for reprints: John EV, MCh, DNB, Medical Trust Hospital, Cardiac Surgery, M G Road, Kochi, Kerala 682016, India. (Email: john1ev@hotmail.com).

The first 20% of the full text of this article appears below.

High-velocity accidents are now being reported with alarming regularity. A number of these patients unfortunately do not reach the hospital.

Clinical Summary

A 21-year-old man presented with multiple fractures in the face and extremities. The electrocardiogram showed features of acute anteroseptal myocardial infarction. Echocardiography showed moderate left ventricular (LV) dysfunction with an ejection fraction of 0.4. Chest radiography showed mediastinal widening and minimal left pleural effusion. A spiral computed tomography angiogram revealed a huge mediastinal hematoma and transection of the arch of aorta between the left common carotid artery (LCCA) and the left subclavian artery (LSCA) with no active bleeding.

After various options were considered, the decision was made to treat the aortic and suspected coronary injury conservatively until the patient was stabilized. Repeat imaging revealed no worsening in the pleural effusion or hematoma.

A computed tomographic angiogram at 12 weeks revealed a pseudoaneurysm in the arch of aorta between the LCCA and the LSCA involving approximately three fourths of the circumference (Go Figure 1, A). Coronary angiogram demonstrated dissection of the proximal . . . [Full Text of this Article]






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