Trauma to the Heart and Great Vessels

  • Ankur Bakshi
  • Matthew J. WallJr.
  • Ravi K. GhantaEmail author


Thoracic trauma, with the potential for injury of the heart or great vessels, is associated with high morbidity and mortality. Clinical suspicion of injury, with logical and sequential evaluation, followed by timely intervention is required to optimize survival. Operative evaluation and repair of injuries may be performed via median sternotomy, left or clamshell thoracotomy, and supraclavicular approaches. Endovascular techniques to repair aortic and subclavian injuries are increasing and are important tools for the management of great vessel trauma.


ATLS protocols Blunt aortic injury Blunt cardiac injury Penetrating cardiac injury Thoracic trauma 


  1. 1.
    Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent). 2010;23:349–54.CrossRefGoogle Scholar
  2. 2.
    Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level I trauma center. J Trauma. 2004;57:576–81.CrossRefGoogle Scholar
  3. 3.
    Mollberg NM, Tabachnik D, Farjah F, et al. Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes. Ann Thorac Surg. 2013;96:445–50.CrossRefGoogle Scholar
  4. 4.
    Morse BC, Mina MJ, Carr JS, et al. Penetrating cardiac injuries: a 36-year perspective at an urban, Level I trauma center. J Trauma Acute Care Surg. 2016;81:623–31.CrossRefGoogle Scholar
  5. 5.
    Karmy-Jones R, Namias N, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating chest trauma. J Trauma Acute Care Surg. 2014;77:994–1002.CrossRefGoogle Scholar
  6. 6.
    Branco BC, Musonza T, Long MA, et al. Survival trends after inferior vena cava and aortic injuries in the United States. J Vasc Surg. 2018;68:1880–8.CrossRefGoogle Scholar
  7. 7.
    Mina MJ, Jhunjhunwala R, Gelbard RB, et al. Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center. Am J Surg. 2017;213:1109–15.CrossRefGoogle Scholar
  8. 8.
    Wall MJ, Mattox KL, Chen CD, Baldwin JC. Acute management of complex cardiac injuries. J Trauma. 1997;42:905–12.CrossRefGoogle Scholar
  9. 9.
    Topaloglu S, Aras D, Cagli K, et al. Penetrating trauma to the mitral valve and ventricular septum. Tex Heart Inst J. 2006;33:392–5.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Mattox KL, Flint LM, Carrico CJ, et al. Blunt cardiac injury. J Trauma. 1992;33:649–50.CrossRefGoogle Scholar
  11. 11.
    Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014;98:1134–40.CrossRefGoogle Scholar
  12. 12.
    Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301–6.CrossRefGoogle Scholar
  13. 13.
    Tang AL, Inaba K, Branco BC, et al. Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg. 2011;146:1061–6.CrossRefGoogle Scholar
  14. 14.
    Wall MJ, Tsai PI, Gilani R, Mattox KL. Open and endovascular approaches to aortic trauma. Tex Heart Inst J. 2010;37:675–7.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Kolbeck KJ, Kaufman JA. Endovascular stent grafts in urgent blunt and penetrating thoracic aortic trauma. Semin Intervent Radiol. 2011;28:98–106.CrossRefGoogle Scholar
  16. 16.
    Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;22:99–110.Google Scholar
  17. 17.
    Di Eusanio M, Folesani G, Berretta P, et al. Delayed management of blunt traumatic aortic injury: open surgical versus endovascular repair. Ann Thorac Surg. 2013;95:1591–7.CrossRefGoogle Scholar
  18. 18.
    Gilani R, Ochoa L, Wall MJ, Tsai PI, Mattox KL. Endovascular repair of traumatic aortic injury using a custom fenestrated endograft to preserve the left subclavian artery. Vasc Endovascular Surg. 2011;45:549–52.CrossRefGoogle Scholar
  19. 19.
    Tan TW, Coulter AH, Zhang WW. Percutaneous in situ left subclavian artery fenestration using reentry catheter during endovascular thoracic aortic aneurysm repair. Int J Angiol. 2016;25:e77–80.CrossRefGoogle Scholar
  20. 20.
    Shi Y, Tsai PI, Wall MJ, Gilani R. Intravascular ultrasound enhanced aortic sizing for endovascular treatment of blunt aortic injury. J Trauma Acute Care Surg. 2015;79:817–21.CrossRefGoogle Scholar
  21. 21.
    Johnston RH, Wall MJ, Mattox KL. Innominate artery trauma: a thirty-year experience. J Vasc Surg. 1993;17:134–9.CrossRefGoogle Scholar
  22. 22.
    Feliciano DV. Management of penetrating injuries to carotid artery. World J Surg. 2001;25:1028–35.CrossRefGoogle Scholar
  23. 23.
    Nagpal P, Policeni BA, Bathla G, Khandelwal A, Derdeyn C, Skeete D. Blunt cerebrovascular injuries: advances in screening, imaging, and management trends. AJNR Am J Neuroradiol. 2018;39:E103. Available from Scholar
  24. 24.
    Sobnach S, Nicol AJ, Nathire H, Edu S, Kahn D, Navsaria PH. An analysis of 50 surgically managed penetrating subclavian artery injuries. Eur J Vasc Endovasc Surg. 2010;39:155–9.CrossRefGoogle Scholar
  25. 25.
    Gilani R, Tsai PI, Wall MJ, Mattox KL. Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients. J Trauma Acute Care Surg. 2012;73:771–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ankur Bakshi
    • 1
  • Matthew J. WallJr.
    • 1
    • 2
  • Ravi K. Ghanta
    • 1
    • 3
    Email author
  1. 1.Michael E. Debakey Department of SurgeryBaylor College of MedicineHoustonUSA
  2. 2.Ben Taub General HospitalHoustonUSA
  3. 3.Cardiac SurgeryBen Taub General HospitalHoustonUSA

Personalised recommendations