Traumatic Dissection of the Ascending Aorta Complicated by Multiple Injuries Following a Traffic Accident

Abstract

Trauma to the ascending aorta may progress to a cardiac tamponade, which is often life-threatening. Here, we report on a case of traumatic dissection of the ascending aorta, complicated by multiple injuries. A 24-hour follow-up period was provided to evaluate the traumatic bleeding, and a large tear that extended over three-quarters of the circumference of the aortic intima was identified. An ascending aorta and partial arch replacement were successfully performed. The timing of cardiopulmonary bypass surgery in cases of multiple traumas must be sufficiently flexible to accommodate the condition of each patient, considering the risk of sudden hemodynamic collapse.

Keywords: cardiopulmonary bypass surgery; multiple trauma; optimal surgical timing; traffic accident; traumatic ascending aorta dissection.

Figure 1. Preoperative contrast-enhanced computed tomography

(A) Computed tomography (CT) reveals a sternal fracture; (B) The extent of the aortic dissection is localized with tears from the pulmonary artery to the posterior wall; (C) CT reveals acute ascending aortic dissection and coarse subcutaneous emphysema; (D) CT reveals pulmonary contusion and traumatic left hemopneumothorax Subsequently, a thoracic drain was inserted.

Figure 2. Surgical findings

(A) Pericardial incision revealed more than moderate amounts of hemorrhagic pericardial effusion and hematoma on the mediastinal side; (B) The ascending aorta was incised, and a large tear that extended over three-quarters of the circumference of the aortic intima was identified