CASE
An 85-year-old woman was admitted to our hospital with a high-energy
motor vehicle trauma. The computed tomography (CT) imaging showed
ascending aortic dissection (DeBakey Type II), right clavicle fracture,
and left first rib fracture. (Figure 1) The abdomen was bruised, and
seatbelt trauma was suspected. To reduce the risk of hemorrhagic
complication with use of cardiopulmonary bypass, the patient was placed
on strict blood pressure control and scheduled for aortic replacement in
a few days. On the second day after admission, the patient became
delirious, inducing a progression of dissection from the ascending to
the descending aorta. (Figure 2) An emergent ascending aortic
replacement was performed. (Figure 3) The patient was transferred for
further rehabilitation on a postoperative day 33.
Traumatic aortic dissection by blunt trauma is rare, and it is often
complicated with other hemorrhagic organ injuries. Since the use of
cardiopulmonary bypass can exacerbate hemorrhagic complications, standby
aortic repair for traumatic Type A dissection under strict blood
pressure control can be a therapeutic option. 1However, conservative treatment has a risk of progression of the
dissection, as in this case, and atelectasis, delirium, and deep venous
thrombosis formation. Ito et al. have reported successful emergent
aortic repair for traumatic aortic dissection with sternum
fracture.2 Although the risk of hemorrhagic
complications must be evaluated, prompt aortic repair is required for
traumatic ascending aortic dissection.