Deep hypothermic circulatory arrest for repair of the brachiocephalic artery and aorta after a gunshot wound to the chest.

The incidence of penetrating trauma to the brachiocephalic artery and aortic arch is not known, because most patients die of hemorrhage before they receive adequate treatment. Furthermore, when torrential hemorrhage from penetrating trauma is present, the anatomy of the thoracic vasculature can present a challenge for gaining adequate exposure, achieving vascular control, and performing proper repair. We describe the case of a patient with a gunshot wound to the anterior chest; he was placed under cardiopulmonary bypass and deep hypothermic circulatory arrest while we performed a patch repair of the proximal brachiocephalic artery and aortic arch.