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Boutaleb AM, Tabat M, Mekouar Y, Bennani G, Drighil A, Habbal R. Rare case series of adult interrupted aortic arch. J Cardiol Cases 2023; 28:206-209. [PMID: 38024110 PMCID: PMC10658337 DOI: 10.1016/j.jccase.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 12/01/2023] Open
Abstract
Interrupted aortic arch (IAA) is a rare congenital heart condition where there is a complete discontinuation between the ascending and descending aorta. The association with a patent ductus arteriosus or developed arterial collateral allows survival until adulthood in extremely rare cases. We report a case series of adult forms of IAA. Even if the incidence is very rare, IAA should be could excluded in the setting of resistant asymmetrical hypertension. The first case is singular regarding its association with a bicuspid aortic valve and aortic aneurysm, while the second case is characterized by massive left ventricular hypertrophy. The diagnosis was suspected on echocardiographic findings and confirmed by computed tomography angiography. Both patients refused surgical repair given the high operative risk. Learning objectives -The evaluation of severe resistant high blood pressure should include complementary investigation for adult form interrupted aortic arch.-To understand the major impact of multimodality imaging for the recognition, localization, and stratification of interrupted aortic arch.
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Affiliation(s)
| | - Meryem Tabat
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Younes Mekouar
- Radiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Ghita Bennani
- Radiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdenasser Drighil
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Rachida Habbal
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
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Gan Y, Zhang P, Liao R, Nie Y, Fu Y. Novel interrupted aortic arch: A case report. J Card Surg 2022; 37:5639-5642. [PMID: 36378947 DOI: 10.1111/jocs.17223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Yang Gan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Pei Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ruili Liao
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yongmei Nie
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Yong Fu
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
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Sharma A, Neupane NP, Dhakal P, Sharma S, Sitaula A, Rajlawot K. Complete interruption of aortic arch diagnosed in adulthood: a case report. Radiol Case Rep 2022; 17:3963-3965. [PMID: 35991382 PMCID: PMC9388869 DOI: 10.1016/j.radcr.2022.07.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 10/25/2022] Open
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Ren SX, Zhang Q, Li PP, Wang XD. Difference and similarity between type A interrupted aortic arch and aortic coarctation in adults: Two case reports. World J Clin Cases 2022; 10:3472-3477. [PMID: 35611201 PMCID: PMC9048566 DOI: 10.12998/wjcc.v10.i11.3472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/02/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Si-Xie Ren
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Qian Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Pan-Pan Li
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xiao-Dong Wang
- Department of Radiology, Sichuan Cancer Hospital, Chengdu 610000, Sichuan Province, China
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Tagorti M, Hakim K, Msaad H, Ouaghlani K, Ben Othmen R, Ouarda F. Interrupted aortic arch: Is it always a neonatal emergency? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2021.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jiang Y, Wang C, Jiang X, Chen S. Is surgery necessary for adults with isolated interrupted aortic arch?: Case series with literature review. J Card Surg 2021; 36:2467-2475. [PMID: 33844339 DOI: 10.1111/jocs.15525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Yefan Jiang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Wang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xionggang Jiang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Undiagnosed type B interrupted aortic arch without a patent ductus arteriosus identified during adolescence. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vaideeswar P, Marathe S, Singaravel S, Anderson RH. Discontinuity of the arch beyond the origin of the left subclavian artery in an adult: Interruption or coarctation? Ann Pediatr Cardiol 2018; 11:92-96. [PMID: 29440839 PMCID: PMC5803986 DOI: 10.4103/apc.apc_91_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology, Division of Cardiovascular and Thoracic Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Supreet Marathe
- Dr. PK Sen Department of Cardiovascular and Thoracic Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Saranya Singaravel
- Department of Pathology, Division of Cardiovascular and Thoracic Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Suntratonpipat S, Bamforth SD, Johnson AL, Noga M, Anderson RH, Smallhorn J, Tham E. Childhood presentation of interrupted aortic arch with persistent carotid ducts. World J Pediatr Congenit Heart Surg 2015; 6:335-8. [PMID: 25870362 DOI: 10.1177/2150135114560830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interrupted aortic arch is a rare condition with typical presentation within the first few weeks of life, as the circulation is dependent upon patency of the arterial duct. Most cases are associated with intracardiac anomalies, the most common being a ventricular septal defect with some degree of hypoplasia and/or obstruction of the left ventricular outflow tract. Presentation beyond infancy is uncommon, and suggests the presence of well-developed collateral circulation. This case of childhood presentation of interrupted aortic arch and intact ventricular septum highlights the very unusual finding of bilateral collateral arteries consistent with persistent carotid ducts. Cardiac MRI angiography with three-dimensional reconstruction defined not only the site of interruption in the aortic arch but also the entire collateral circulation.
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Affiliation(s)
| | - Simon D Bamforth
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy-Leigh Johnson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michelle Noga
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeffrey Smallhorn
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Edythe Tham
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada
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Liping C, Pradhan D, Jing Z, Hongwei Z, Shrestha R. Isolated interrupted aortic arch in 42-year-old adult--case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:521-523. [PMID: 22865714 DOI: 10.1002/jcu.21973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/14/2012] [Indexed: 06/01/2023]
Abstract
Interrupted aortic arch (IAA) is a rare congenital anomaly characterized by a complete luminal and anatomical interruption between the ascending and descending thoracic aorta. It is usually detected in the perinatal period or during infancy, but a very few cases have been reported in adults. Here, we present the case of a 42-year-old man who visited our hospital for arterial hypertension and in whom IAA was diagnosed with echocardiography and confirmed by computed tomography angiography.
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Affiliation(s)
- Chen Liping
- Department of Echocardiography, Cardiovascular Disease Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, P.R. China
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