Abstract
A 63-year old woman was transferred to our hospital due to a motor vehicle accident. Enhanced computed tomography showed aortic arch intramural haematoma and pericardial effusion. The patient lost consciousness, and we thought that the cardiac tamponade was indeed due to intrapericardial rupture of the aorta. The emergency operation was started via a median sternotomy, and the femoral vessels were simultaneously exposed for possible peripheral cannulations. After cardiopulmonary bypass was started through the peripheral cannulations, we fully opened the pericardium and identified bleeding from a 2-cm tear in the right atrium. The culprit lesion was repaired using a 4-0 polypropylene suture with a felt strip. Next, total arch replacement with a four-branched knitted prosthetic graft was performed. Over two-thirds of the intima was circumferentially ruptured at the level of the aortic isthmus. Postoperative neurological complications did not arise.