Operative challenges in management of concurrent interrupted aortic arch and descending thoracic aortic aneurysm

A Case of Interrupted Aortic Arch in an Adult: An Unsuspected Cause of Uncontrolled Hypertension

In this paper, we describe an incidentally discovered case of interrupted aortic arch in a 28-year-old male patient with a history of long-standing poorly controlled hypertension. The patient presented to the hospital with a complaint of upper respiratory complaints and long-standing chest pain. A plain chest radiograph was requested to exclude a diagnosis of pneumonia, and the radiography spotted an incidental finding of inferior rib notching. A subsequent CT angiography was done for further characterization, and a diagnosis of interrupted aortic arch was confirmed. Therefore, although rare, IAA should be considered in adults with refractory hypertension or unexplained congestive heart failure.

Type B Interrupted Aortic Arch With a Very Large Right Subclavian Artery Aneurysm in an Adult

Interruption of the aortic arch and right subclavian artery aneurysm is a rare congenital malformation. Survival in adults depends on the formation of collaterals to supply the descending aorta. The interruption of the aortic arch must be taken into account, particularly in patients with hypertension and weak pulses in the lower extremities. We present a case of aortic arch interruption and a right subclavian artery aneurysm in a woman who survived to adulthood.

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.

Interrupted right-sided aortic arch: performance of umbilical xenograft after primary neonatal corrective surgery

Interrupted aortic arch (IAA) associated with right-sided aorta descendens is a rare congenital malformation. We present a case of a female patient who was diagnosed with type B IAA and received primary corrective surgery as a neonate. A bovine umbilical vascular graft was used to establish aortic arch continuity. Thirty-nine years later the same patient presents with graft-dilatation and a distal aneurysm requiring a surgery. This case shows a late complication of a biological xenograft in term of long-term material performance. Moreover, it highlights the necessity for regular follow-ups in order to detect and treat late onset complications respectively.

Discontinuity of the arch beyond the origin of the left subclavian artery in an adult: Interruption or coarctation?

Congenital aortic anomalies are uncommon causes of secondary hypertension and are seldom suspected in the adult age group. We present a case of aortic interruption unexpectedly diagnosed on autopsy in a 38-year-old male who presented with cardiovascular collapse. Apart from interruption, a finding unique to our case was aneurysmal dilation of the proximal descending aorta just before the obstruction with thrombosis. We also attempt to review the literature for interrupted aortic arch in adults and clarify the nomenclature of interruption versus coarctation.

Interrupted aortic arch with post-interruption aneurysm and bicuspid aortic valve in an adult: a case report and literature review

Interrupted aortic arch in adults is rare with a limited number of reported cases. We describe a case of a 53-year-old woman with interrupted aortic arch, bicuspid aortic valve, and post-interruption saccular aneurysm of the aorta. To our knowledge, this is only the second report of an adult patient with all 3 abnormalities. We also review the literature on this unusual condition and discuss its relationship with coarctation of the aorta.