A rare pediatric case of cluster headaches after cardiac catheterization in a patient with an isolated innominate artery

While cluster headaches are classified and considered a primary headache disorder, secondary causes of cluster headaches have been reported and may provide insight into cluster headaches’ potential pathophysiology. The mechanisms underlying this headache phenotype are poorly understood, and several theories have been proposed that range from the activation within the posterior hypothalamus to autonomic tone dysfunction. We provide a review of reported cases in the literature describing secondary causes after cardiac procedures. We will present a novel pediatric case report of a 16-year-old boy with an isolated innominate artery who presented with acute new-onset headaches 8 h following cardiac catheterization of the aortic arch with arteriography and left pulmonary artery stent placement. The headaches were characterized by attacks of excruciating pain behind the left eye and jaw associated with ipsilateral photophobia, conjunctival injection, rhinorrhea, with severe agitation and restlessness. These met the International Classification of Headache Disorders-3 criteria for episodic cluster headaches. The headaches failed to respond to non-steroidal anti-inflammatory medications, dopamine antagonists, and steroids. He showed an immediate response to treatment with oxygen. This unique case of cluster headaches following cardiac catheterization in a pediatric patient with an isolated innominate artery may provide new insight into cluster headaches’ pathogenesis. We hypothesize that the cardiac catheterization induced cardiac autonomic changes that contributed to the development of his cluster headaches. The role of aortic arch anomalies and procedures in potential disruption of the autonomic tone and the causation of cluster headaches is an area requiring further study.

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Surgical Palliation of Right Aortic Arch With an Isolated Innominate Artery From the Left Ductus Arteriosus

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117737688 ◽

2018 ◽

Vol 9 (1) ◽

pp. 98-100 ◽

Cited By ~ 1

Author(s):

Matthew C. Schwartz ◽

Kamal Pourmoghadam ◽

Michael O’Brien ◽

Craig E. Fleishman ◽

William DeCampli

Keyword(s):

Patent Ductus Arteriosus ◽

Aortic Arch ◽

Ductus Arteriosus ◽

Innominate Artery ◽

Ascending Aorta ◽

Right Aortic Arch ◽

Pedicle Flap ◽

Surgical Palliation ◽

Isolated Innominate Artery ◽

Patent Ductus

A right aortic arch with an isolated left innominate artery from the left patent ductus arteriosus is a rare arch anomaly, and establishing continuity between the innominate artery and aorta can be challenging. We describe repair of this lesion in a three-week-old male using an autologous pedicle flap of ascending aorta as well as a homograft patch as the roof to recreate continuity between the aorta and left innominate artery.

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Management of a spontaneous supra-aortic arterial dissection: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02886-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Omar M. Sharaf ◽

Tomas D. Martin ◽

Eric I. Jeng

Keyword(s):

Innominate Artery ◽

Operative Management ◽

Computed Tomographic Angiography ◽

Artery Dissection ◽

Term Therapy ◽

Type I ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Aortic Dissections ◽

Isolated Innominate Artery

Abstract Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

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Coarctation of the aorta with right aortic arch and isolation of the left innominate artery: A surgical challenge in a patient without collateral posterior brain circulation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(98)70179-5 ◽

1998 ◽

Vol 116 (4) ◽

pp. 657-659 ◽

Cited By ~ 7

Author(s):

C. Delgado ◽

F. Barturen

Keyword(s):

Aortic Arch ◽

Coarctation Of The Aorta ◽

Innominate Artery ◽

Right Aortic Arch ◽

Brain Circulation

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Penetrating Injuries to the Innominate Artery in Association with Abnormal Aortic Arch Anatomy

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.2002.1631 ◽

2002 ◽

Vol 23 (5) ◽

pp. 462-464

Author(s):

J.D. Woolgar ◽

J.V. Robbs ◽

P. Rajaruthnum ◽

G.S. Mohamed

Keyword(s):

Aortic Arch ◽

Innominate Artery ◽

Penetrating Injuries

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One-Stage Repair of Cardiac and Arch Anomalies without Circulatory Arrest

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100315 ◽

2003 ◽

Vol 11 (3) ◽

pp. 250-254 ◽

Cited By ~ 1

Author(s):

Kona Samba Murthy ◽

Robert Coelho ◽

Christopher Roy ◽

Snehal Kulkarni ◽

Benjamin Ninan ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Aortic Arch ◽

Septal Defect ◽

Circulatory Arrest ◽

Coarctation Of The Aorta ◽

Innominate Artery ◽

Double Outlet Right Ventricle ◽

Interrupted Aortic Arch ◽

Ischemic Time ◽

Arch Obstruction

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1–43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.

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