Ann Thorac Surg 2002;73:666
© 2002 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Traumatic aortic arch injury
Kirit Patel, MDa,
Keith Allen, MDa,
Clay Hinrichs, MDb,
Ayad Jihayel, MDa,
James S. Donahoo, MD*a
a Division of Cardiothoracic Surgery, University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey, USA
b Department of Radiology, University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey, USA
* Address reprint requests to: Dr Donahoo, Division of Cardiothoracic Surgery, UMDNJ-New Jersey Medical School, 185 South Orange Avenue, MSB G 595, Newark, NJ 07103-2714, USA
e-mail: jamdonahoo{at}netscape.net
A 53-year old man was involved in a motor vehicle accident. The airbag was deployed at the time. A chest x-ray film showed a widened superior mediastinum. A spiral computed tomographic scan of the chest revealed fluid around the aortic arch (Fig 1). An aortogram revealed a hematoma and tear at the base of the innominate artery (IA) extending onto the arch (Fig 2).
Three-dimensional computed tomographic reconstructions of the aortic arch depicted a hematoma on the posterior aspect of the arch at the base of the innominate artery extending to the left common carotid (LCC) (Fig 3 and 4).
He was emergently taken to the operating room for repair of the aortic arch trauma.
At operation, the left femoral artery was cannulated. The sternum was opened in the midline. The pericardium was free of blood. The right atrium was cannulated with a dual-stage venous cannula. The anterior aspect of the innominate artery was clean. While dissecting laterally to the innominate artery, a hematoma was found. The patient was placed on CPB and cooled to 15°C. A proximal anastomosis (side of ascending aorta to end of 8-mm Dacron [C. R. Bard, Haverhill, PA] graft) was completed. At circulatory arrest, the hole was identified at the base of the innominate artery extending to the base of the left common carotid artery. The innominate artery was transected. The defect was repaired with a Dacron patch. Total circulatory arrest time was 16 minutes. A distal anastomosis (end of 8-mm Dacron graft to end of innominate artery) was performed. The patient was weaned off the pump without difficulty. Postoperatively the patient did well, and there were no neurologic complications. (AP = anterior posterior projection; LSC = left subclavian artery.)
