Isolated interrupted aortic arch in adulthood: A case report

Novel interrupted aortic arch: A case report

BACKGROUND AND AIM OF THE STUDY

Interrupted aortic arch (IAA) is a rare and fatal malformation. Most patients with IAA are diagnosed in early childhood because of the severity of their symptoms. IAA is classified into three morphologic types (A, B, or C), depending on the site of the interruption. In our case, this patient did not have a common brachiocephalic trunk, left carotid artery, or left subclavian artery, IAA classification of this case cannot be judged based on the existing interruption method.

METHODS

We present a 6-year-old Chinese boy with a history of neck masses since birth, and an echocardiogram from a local county hospital revealing an IAA without any cardiac anomalies, was referred to our hospital.

RESULTS

The patient was feeling good and was nearly asymptomatic. Computed tomography angiography was performed, which indicated an absent aortic arch, likely due to disruption during development, and aortic discontinuity. The ascending aorta gave rise to both carotid arteries, and the descending aorta was supplied by large subclavian arteries. The right vertebral artery was supplied by right large collateral vessels that connected the right carotid artery. The left side was similar in structure to the right side. The descending aorta was supplied by large subclavian arteries. The subclavian arteries and carotid arteries were connected by large collateral vessels. Due to the large collateral vessels, the child's lower body had sufficient blood supplied, so that the typical differential cyanosis did not occur, and the child without symptomatic can survive to now.

CONCLUSIONS

This patient did not have a common brachiocephalic trunk, left carotid artery, or left subclavian artery. Maybe, this patient belonged to a new type of IAA.

Difference and similarity between type A interrupted aortic arch and aortic coarctation in adults: Two case reports

BACKGROUND

Aortic coarctation (CoA) is usually confused with interrupted aortic arch (IAA), especially adult type A interrupted aortic arch, due to their similar anatomical location. Although the main difference between them is whether arterial lumen exhibits continuity or not, the clinical manifestations are similar and connection exists between them. Adult type A IAA is considered as an extreme form of CoA, which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation. This paper reports two cases (interrupted aortic arch and severe aortic coarctation) to analyze the difference and similarity between them.

CASE SUMMARY

The two cases of patients presented with hypertension for many years. Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow. The IAA patient refused surgical treatment and blood pressure could be controlled with drugs. While the CoA patient underwent stent implantation because of uncontrollable hypertension, the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.

CONCLUSION

Adult type A IAA and CoA have difference and similarity, and type A IAA is associated with CoA to a certain extent. The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.

Is surgery necessary for adults with isolated interrupted aortic arch?: Case series with literature review

BACKGROUND AND AIM

Interrupted aortic arch (IAA) is defined as a complete interruption of aortic lumen between the ascending and descending aorta. It is an uncommon and complicated congenital heart disease. It is rare for patients with isolated IAA to survive to adulthood without operation. Here we present three rare cases with isolated IAA together with a review of the literature of IAA. Besides, we reviewed reported adult cases with isolated IAA in the last 20 years and summarized the relevant data of the isolated type.

METHODS

We retrospectively searched the hospital databases for adult patients with isolated IAA diagnosed at the Wuhan Union Hospital over the past 10 years. Cases related to adult isolated IAA published in last 20 years were identified by searching Pubmed.

RESULTS

Three adult patients with isolated IAA were identified. Two were referred to us for hypertension management and were diagnosed with IAA. They declined surgical treatments and took antihypertensive medications. One patient was referred to our hospital for further treatment options after diagnosed with IAA at another hospital. He received an extra-anatomic bypass surgery. But his hypertension did not well resolve after surgery, and was subsequently managed by anti-hypertensives medications. 25 published adult patients with isolated IAA were identified in Pubmed and relevant details were summarized.

CONCLUSIONS

Adult patients with isolated IAA usually have extensive collateral vessels joining the descending aorta. Anti-hypertensives medical management with long-term follow-up appears to be a reasonable treatment option for these patients, although surgical intervention is a good choice.

Isolated interrupted of aortic arch diagnosed using CT angiography: A case report and literature review

RATIONALE

Interrupted aortic arch (IAA) is defined as a complete luminal and anatomical interruption between the ascending and descending aortas. The majority of patients with IAA rarely reach adulthood. In most cases, IAA is associated with an intracardiac malformation, such as ventricular septal defect, bicuspidaortic valve, and patent ductus arteriosus. We reported a 70-year-old man with isolated IAA diagnosed using computed tomography angiography (CTA) without previous intervention.

PATIENT CONCERNS

The patient presented with edema of the lower extremities and productive cough.

DIAGNOSES

CTA displayed an interruption of the aortic arch distal to the left common carotid artery (type B) and extensive collateralization.

INTERVENTIONS

The patient refused surgery and underwent conservative therapy with follow-up examinations because of the extensive collateral vascularization.

OUTCOMES

The patient is still currently undergoing conservative therapy with follow-up examinations.

LESSONS

IAA can present in adulthood with different clinical symptoms. Careful physical examination of the lower and upper peripheral pulses in adults with a chief complaint of hypertension is of outmost importance. CTA is a useful noninvasive imaging modality for the morphologic evaluation of aortic interruption and collateral circulation.