Surgical repair of traumatic rupture of the discending aorta through 'L'-thoracotomy

Acute blunt aortic rupture occurs frequently at the aortic isthmus and emergency operation is usually required. A 33-year-old man was suffered with blunt traumatic thoracic aortic injury caused by traffic accident and emergency operation was performed due to hemodynamic instability. The patient was operated through 'L'-thoracotomy (upper part sternotomy and antero-lateral thoracotomy). Cardiopulmonary bypass was initiated with right femoral vein drainage and right femoral arterial return and converted to standard cardiopulmonary bypass with the ascending aorta return and right atrium appendage drainage when the discending aorta was re-ruptured. It stabilized the circulation of upper body, especially brain. The post-operative course was uneventful. The 'L'-thoracotomy can provide good operative exposure for the aortic isthmus and stabilize the circulation of the brain with standard cardiopulmonary bypass and clamping the descending aorta.