And you thought you were having a bad day!
Believe it or not, this picture is from a real case report.
What's amazing about this case is that the wound was self-inflicted.
Even more amazing, the patient survived! |
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Traumatic Aortic Transection
(Blunt Traumatic Tear of the Aorta)
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One of the most serious injuries that we see to the cardiovascular
system is a blunt injury to the aorta, causing it to literally tear in
half.
Typically the tear is located in the descending aorta, just distal to
the take off of the left subclavian artery that goes to the left arm as
shown above.
The most common cause of this injury is from a person who is an
unrestrained driver or passenger in a car, meaning that they were not
wearing their seatbelt.
It turns out that there is a ligament that attaches to the aorta just
at the level of the left subclavian artery, thus fixing the artery at
this point. In a care accident, or any deceleration injury, the
part of the aorta attached to the ligament stays still while the more
distal aorta continues to move thus causing tremendous stress on the
artery and tearing it at this location.
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To the right is an arteriogram showing the torn aorta and the blood leaking
out. The mortality rate from this injury is very high.
Unfortunately, most patients with this injury die at the scene of the
accident.
However, if the bleeding is contained, and if the patient can be
rapidly transferred to a Level I Trauma Center such as Lehigh Valley
Hospital, then the patient may have a chance to survive.
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In patients who arrive at our trauma center in stable condition, our
success rate is well over 90%.
Even so, it is a high risk procedure that should only be done by
experienced cardiothoracic surgeons.
We have published our results at Lehigh Valley Hospital and I am
pleased to say our outcomes are among the best in the nation.
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Surgery for Aortic Transection
Immediate surgery through the
left chest is needed.
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Usually, the torn aorta needs to be replaced with an inter-position
tube graft as shown below. |
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Modern techniques using the heart-lung machine have greatly reduced
the complications from this procedure.
Two serious complications still challenge even the most experienced
heart surgeons:
First, paralysis of the left vocal cord from injury to the left
recurrent laryngeal nerve that lies lies next to the aorta.
Secondly, and even more devastating when it occurs, paralysis of the
lower extremities due to a loss of blood supply to the spinal cord
during surgery. |
As in other areas of cardiovascular surgery, there is
early research on the use of stents for trauma to the aorta.
However, at this time, the standard of care with the most proven results
is the surgery that I outlined above. |
