HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Riyad Karmy-Jones Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Karmy-Jones, R. Articles by Bloch, R. D. Search for Related Content PubMed PubMed Citation Articles by Karmy-Jones, R. Articles by Bloch, R. D. Related Collections Great vessels

Ann Thorac Surg 2003;75:1513-1517
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Management of traumatic rupture of the thoracic aorta in pediatric patients

^a Divisions of Cardiothoracic/Trauma, Harborview Medical Center, University of Washington, Seattle, Washington, USA
^b Interventional Radiology, Harborview Medical Center, University of Washington, Seattle, Washington, USA
^c Vascular/Trauma, Harborview Medical Center, University of Washington, Seattle, Washington, USA

Accepted for publication November 14, 2002.

^* Address reprint requests to Dr Karmy-Jones, Box 359796, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, USA
e-mail: karmy{at}u.washington.edu

BACKGROUND: Traumatic rupture of the thoracic aorta (TRA) in the pediatric population is uncommon. Management of TRA in general has evolved to include selective nonoperative and endovascular stent graft approaches, although operative repair remains the standard.

METHODS: We conducted a retrospective chart review of patients younger than 16 years of age admitted to a single institution between March 1985 and February 2002.

RESULTS: Of 160 patients admitted with TRA, 11 were younger than 16 (11.9 ± 3.5) years of age. Concomitant injuries included closed head injury (5 patients) and acute lung injury (6 patients). All were started on ß-blockers when the diagnosis was suspected. Laparotomy was required in 3 patients and orthopedic procedures in 5 patients. Six underwent operative repair (two primary repairs), with no mortality. Cross-clamp time was 30.4 ± 2.6 minutes. One patient (operated on without bypass) was partially paralyzed. Two patients were managed nonoperatively, 1 with an intimal arch injury, who on subsequent follow-up has demonstrated healing, and 1 who died of head injury. Three patients were managed by endovascular stent grafts, 2 who died of closed head injury and 1 who at 1-year follow-up has fully recovered. The endovascular stent grafts were placed through the femoral artery in 2 patients and through an iliac conduit in 1 patient. No patient died of rupture.

CONCLUSIONS: The approach to pediatric TRA should be identical to the adult, with early institution of ß-blockers. Depending on the clinical setting, a spectrum of options should be considered, including operation, nonoperation, and endovascular stent graft, although the choice of the latter must be tempered by the lack of long-term follow-up data.

This article has been cited by other articles:

				M. Kerr and I. Maconochie Paediatric chest trauma (part 2) -- Hidden Injuries Trauma, July 1, 2008; 10(3): 195 - 210. [Abstract] [PDF]

				J. S. K. Murala, A. Numa, and P. Grant Traumatic rupture of the aorta in children--stenting or surgical intervention? A word of caution J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 731 - 732. [Full Text] [PDF]