Paper Information

Journal:   JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)   FALL 2006 , Volume 24 , Number 82 (SUPPLEMENT); Page(s) 54 To 59.
 
Paper: 

CAN PROPHYLACTIC RIGHT SUBCLAVIAN ARTERY CANNULATION PROTECT AGAINST BRAIN DAMAGE DURING TRAUMATIC AORTIC TRANSECTION REPAIR?

 
 
Author(s):  SAEIDI MAHMOUD*
 
* CHAMRAN HEART CENTER, ISFAHAN UNIVERSITY OF MEDICAL SCIENCES, ISFAHAN, IRAN
 
Abstract: 

Blunt traumatic aortic transection (TAT) is an uncommon injury with high morbidity and mortality. There has been controversy about the diagnostic methods, approach to the injury, repair time, and surgical techniques. Active augmentation of distal perfusion pressure during cross clamp is still considered as the best surgical treatment. Today, helical CT scan has replaced angiography as the best diagnostic method. There is an incidence of life-threatening arrhythmia such as ventricular fibrillation (VF) during TAT repair, especially in critically unstable patients. One of the catastrophic events, especially occurring in hemodynamically unstable patients (due to multiple trauma and/or myocardial contusion) or severely anemic patients (due to hemorrhage from different body sites) or hypoxic patients (due to myocardial and/or lung contusion) are dangerous cardiac arrhythmias, especially VF due to the manipulation of TAT site or unexpected hemorrhage from the TAT site. Meanwhile, if aorta is clamped on both sides of the TAT site despite the patient being on full cardiopulmonary bypass (CPB) through femoral cannulation, VF carries the risk of low perfusion in the ascending aorta and the arch of aorta and subsequent brain hypoxia and damage. Prophylactic cannulation of the right subclavian artery at the beginning of the surgery, in addition to femoral cannulation before left thoracotomy, can be life-saving for the patients. Presented in this report is a 21-year-old man with multiple trauma and severe head injury due to a motorcycle accident who developed TAT. First, the patient underwent cannulation of femoral artery and vein, as well as cannulation of the right subclavian artery. After opening the left pleural cavity with posterolateral thoracotomy incision, full CPB was started through femoral cannulation. The patient suddenly developed VF during manipulation of the TAT site. The right subclavian artery cannula was immediately opened resulting in complete perfusion of ascending aorta and arch of aorta preventing brain hypoxia.
Conclusions: Prophylactic right subclavian artery cannulation in TAT repair, especially in hemodynamically unstable or hypoxic patients, or those with severe anemia can create a safe margin for the surgeon to prevent brain damage during this high-risk-operation.

 
Keyword(s): AORTIC RUPTURE, BLUNT TRAUMA, ETIOLOGY, DIAGNOSIS, MANAGEMENT
 
References: 
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