Congenital native interruption of aortic arch in an adult: Extra-anatomic approach by right-side thoracotomy

Abstract

We outline the case of an 18-year-old male patient with a congenital nonoperated interruption of the aortic arch. A right thoracotomy without cardiopulmonary bypass facilitated repair through an extra-anatomic bypass between the ascending and the supradiaphragmatic descending aorta. Results for the immediate and 2-year radiologic and clinical check-up were satisfactory. The most common complications in anatomic correction are stroke under selective cerebral perfusion, risk of paraplegia, and hemorrhage. We present a new technique for repair of interruption of the aortic arch in adults that avoids the need for extended dissection of the aorta and a partial occlusion clamp during anastomosis and allows for cerebral and medullar perfusion.

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

“…Among 29 confirmed cases of interruption identified in adults reported in the past 10 years,[ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ] there were 21 males and 8 females, with ages ranging from 18 to 62 years, with a mean of 37.7 years. The interruption at the isthmus is more common in adults, being found in three-quarters of instances, in comparison to interruption beyond the origin of the left common carotid artery, or “Type B,” in children.…”

Off-pump Aortic Arch Interruption Surgery: Anesthetic Management and Outcomes

“…Postoper ative follow-up may still reveal issues with long-term hypertension, aortic arch reobstruction, and left ventricular outflow tract obstr uction [12]. Adult patients with congenital nonsurgical aortic arch i nterruption have been treated with an off-pump right thoracotom y technique [13]. By establishing an extraanatomical bypass betwee n the ascending aorta and the descending upper thoracic aorta, t his surgical technique can repair disruptions in the aortic arch.…”