TRAUMATIC RUPTURE OF THE THORACIC AORTA - 10-YEAR EXPERIENCE WITH FOLLOW-UP

In the past 10 years, 13 cases of acute traumatic rupture of the thoracic aorta were treated at the Dunedin Hospital. Ages ranged from 16 to 77 years, with a mean of 27 years. Twelve of the patients were involved in high speed motor vehicle accidents and one sustained a fall. The diagnosis was suspected in all 13 cases by a widened mediastinum on plain chest X-ray and confirmed by aortography in all cases. Associated injuries were common. The time interval from injury to surgery ranged from 5 h to 16 days, with a mean of 3 days. A Gott Shunt was used in five patients, seven had partial bypass and one had simple aortic cross-clamping. Mean aortic cross-clamp time was 62 min. Mortality was 15%, both deaths occurring in the bypass group. There were two cases of paraplegia, one occurring in the bypass group and the other in the patient having simple cross-clamping of the aorta. Follow up was possible in 8 of 13 patients and ranged from 3 months to 10 years, with a mean of 39 months. Delayed death due to heart failure occurred after discharge in a 77 year old man 40 days after operation. The long-term results were satisfactory in all survivors, apart from one poorly rehabilitated paraplegic.