An unusual case of interrupted cervical aortic arch associated with long segment coarctation of the descending thoracic aorta

AbstractInterrupted aortic arch is a rare congenital anomaly in newborns and infants and is commonly associated with other cardiovascular anomalies. Here, we report an unusual case of type A interrupted cervical aortic arch associated with long segment coarctation of the descending thoracic aorta. Patent ductus arteriosus reconstituted the descending thoracic aorta. Proximal segments of the left common carotid and left subclavian arteries were atretic. Echocardiography-gated multidetector CT angiography not only identified the type of aortic arch interruption in the neonate but also delineated the exact anatomical details.

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Proximal Descending Thoracic Aortic Pseudoaneurysm in a 24-Year-Old Man after 2 Childhood Repairs of Interrupted Aortic Arch

Texas Heart Institute Journal ◽

10.14503/thij-17-6252 ◽

2020 ◽

Vol 47 (1) ◽

pp. 27-29

Author(s):

Saleh A. Alnasser ◽

Angela H. Martin ◽

Ourania A. Preventza ◽

Joseph S. Coselli ◽

Kim I. de la Cruz

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Left Subclavian Artery ◽

Survival Rates ◽

Interrupted Aortic Arch ◽

Type B ◽

Descending Thoracic Aorta ◽

Term Survival ◽

Aortic Pseudoaneurysm

Improved management of interrupted aortic arch has increased long-term survival rates. Longer life expectancies in neonates and children surgically treated for interrupted aortic arch may necessitate complex reinterventions when sequelae develop in adulthood. We report the case of a 24-year-old man who had undergone initial repair of interrupted aortic arch type B at one week and reintervention at 6 years of age. He presented with a 5.5 × 9-cm pseudoaneurysm of the proximal descending thoracic aorta. He underwent surgical replacement of his distal aortic arch and proximal descending thoracic aorta, with a bypass to his left subclavian artery. In addition to our patient's case, we discuss considerations in treating recipients of early interrupted aortic arch repairs as they live longer and undergo multiple reinterventions.

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Interrupted aortic arch with intact ventricular septum: a multidetector CT angiography evaluation

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology ◽

10.5152/akd.2011.049 ◽

2011 ◽

Vol 11 (2) ◽

Author(s):

Ozlem Barutcu Saygili ◽

Arda Saygili ◽

Ersin Erek ◽

Ayse Sarioglu ◽

Tayyar Sarioglu

Keyword(s):

Aortic Arch ◽

Ct Angiography ◽

Multidetector Ct ◽

Interrupted Aortic Arch ◽

Ventricular Septum ◽

Intact Ventricular Septum ◽

Multidetector Ct Angiography

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Blood flow in the rabbit aortic arch and descending thoracic aorta

Journal of The Royal Society Interface ◽

10.1098/rsif.2011.0116 ◽

2011 ◽

Vol 8 (65) ◽

pp. 1708-1719 ◽

Cited By ~ 39

Author(s):

P. E. Vincent ◽

A. M. Plata ◽

A. A. E. Hunt ◽

P. D. Weinberg ◽

S. J. Sherwin

Keyword(s):

Blood Flow ◽

Aortic Arch ◽

Thoracic Aorta ◽

Ductus Arteriosus ◽

Local Variation ◽

Descending Thoracic Aorta ◽

Local Flow ◽

Descending Aorta ◽

Flow Features ◽

Realistic Representation

The distribution of atherosclerotic lesions within the rabbit vasculature, particularly within the descending thoracic aorta, has been mapped in numerous studies. The patchy nature of such lesions has been attributed to local variation in the pattern of blood flow. However, there have been few attempts to model and characterize the flow. In this study, a high-order continuous Galerkin finite-element method was used to simulate blood flow within a realistic representation of the rabbit aortic arch and descending thoracic aorta. The geometry, which was obtained from computed tomography of a resin corrosion cast, included all vessels originating from the aortic arch (followed to at least their second generation) and five pairs of intercostal arteries originating from the proximal descending thoracic aorta. The simulations showed that small geometrical undulations associated with the ductus arteriosus scar cause significant deviations in wall shear stress (WSS). This finding highlights the importance of geometrical accuracy when analysing WSS or related metrics. It was also observed that two Dean-type vortices form in the aortic arch and propagate down the descending thoracic aorta (along with an associated skewed axial velocity profile). This leads to the occurrence of axial streaks in WSS, similar in nature to the axial streaks of lipid deposition found in the descending aorta of cholesterol-fed rabbits. Finally, it was observed that WSS patterns within the vicinity of intercostal branch ostia depend not only on local flow features caused by the branches themselves, but also on larger-scale flow features within the descending aorta, which vary between branches at different locations. This result implies that disease and WSS patterns in the vicinity of intercostal ostia are best compared on a branch-by-branch basis.

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Aortic dissection in a young male with isolated interrupted aortic arch: an unusual association

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1404 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Shekhar Kunal ◽

Pooja Pathak ◽

Shruti Mittal ◽

Vijay Pathak ◽

Prateek Vaswani

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Aortic Arch ◽

Thoracic Aorta ◽

Adult Population ◽

Young Male ◽

Acute Chest Pain ◽

Interrupted Aortic Arch ◽

Lower Limbs ◽

Descending Thoracic Aorta

Interruption of the aortic arch (IAA) is a rare congenital anomaly which has been infrequently documented in the adult population. Aortic dissection (AD) is an emergency often presenting as acute chest pain and warranting urgent intervention. A 32-year-old male presented to Emergency Department with acute chest pain. Clinical examination revealed feeble pulses in bilateral lower limbs with a blood pressure difference between upper and lower limbs. Two-dimensional Echocardiography was suggestive of IAA with AD in the descending thoracic aorta. This was confirmed on computed tomography scan of the aorta which revealed complete interruption of the aortic arch distal to left subclavian artery along with the presence of an intimo-medial flap in descending thoracic aorta. A diagnosis of IAA with AD was made. The patient underwent an urgent aortic repair surgery following which he has been largely asymptomatic. A suspicion of AD should always be made in any patient presenting with acute onset chest pain radiating to the back along with accelerated hypertension/feeble pulses in extremity. Occurrence of AD in an adult with IAA is a distinct rarity and has been documented only thrice.

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Interrupted aortic arch beyond adolescence repaired by prosthetic vestibule from common carotid-to-descending thoracic aorta

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.08.098 ◽

2014 ◽

Vol 59 (1) ◽

pp. 246-247

Author(s):

Shashidhar Kallappa Parameshwarappa ◽

Nedounsejiane Mandjiny ◽

Vikram Patra ◽

Madathipat Unnikrishnan

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Interrupted Aortic Arch ◽

Descending Thoracic Aorta

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Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

Kazan medical journal ◽

10.17750/kmj2015-377 ◽

2015 ◽

Vol 96 (3) ◽

pp. 377-380

Author(s):

I R Yagafarov ◽

R R Sayfullin ◽

M M Iskhakov ◽

N V Gazizov ◽

M G Khatypov ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Spontaneous Rupture ◽

Open Surgery ◽

Intraoperative Complications ◽

Long Term Results ◽

Safe Procedure ◽

Descending Thoracic Aorta ◽

Prosthetic Repair ◽

Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

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