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

Vaideeswar, Pradeep; Marathe, Supreet P; Singaravel, Saranya; Anderson, Robert H.

doi:10.4103/apc.apc_91_17

Cited by 3 publications

(4 citation statements)

References 20 publications

(29 reference statements)

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“…O tratamento cirúrgico no adulto com IAA tipo A é realizado evitando-se as grandes colaterais por acesso mediano, demonstrando-se efetivo para reestabelecer o fluxo pulsátil distal. Na experiência de Krishna e colaboradores 4 , no Texas Heart Institute, com sete pacientes operados, cinco foram abordados por via mediana, sendo descritas complicações naqueles que foram submetidos a via lateral, em especial pela hemorragia e pelo próprio diâmetro inferior dos enxertos 12 e 16mm, em comparação com nossa casuística cujos diâmetros foram de 18 e 20mm 3 . A via mediana propicia a circulação extracorpórea plena e hipotermia mais acentuada o que evita a possibilidade de grave complicação como isquemia medular durante clampeamento da aorta descendente podendo levar a paraplegia.…”

Section: Resultsunclassified

“…A hipertensão arterial proeminente em membro superior e vasos cerebrais pode evoluir com complicações como hemorragia por rotura de aneurisma cerebral, assim como hipertrofia ventricular esquerda progressiva e morte súbita. 3 O diagnóstico pormenorizado é realizado por angiotomografia computadorizada (AngioTC) ou ressonância nuclear magnética (RNM), entretanto é geralmente precedido de ecocardiograma bidimensional e avaliação clínica rigorosa que inclui medida de pressão arterial nos quatro membros. A avaliação dos vasos cerebrais por estes métodos pode revelar aneurisma cerebral ou má formação arteriovenosa.…”

Section: Introductionunclassified

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Interrupção do Arco Aórtico: Tratamento Cirúrgico no Adulto em um Centro de Referência de Cardiopatia

Rocha¹,

Wanderley²,

Costa³

2020

RCHSI

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A interrupção do arco aórtico (IAA) é uma condição extremamente rara, caracterizada pela interrupção luminal segmentar ou focal. O diagnóstico pormenorizado é realizado por angiotomografia computadorizada (AngioTC) ou ressonância nuclear magnética (RNM) e o tratamento e eminentemente cirúrgico. Entre 2013 e início de 2019, 4 pacientes adultos foram submetidos à cirurgia para tratamento de IAA tipo A no Hospital Santa Izabel (HSI) através da interposição cirúrgica de enxerto por via extra-anatômica, entre a aorta torácica ascendente e descendente, por via mediana. A mediana de permanência dos pacientes na Unidade de Terapia Intensiva (UTI) foi de 3 dias, hospitalar de 7 dias, tempo de acompanhamento médio de 31,2 meses ± 25,3, não havendo nenhuma complicação hemodinâmica, infecciosa ou óbito. Em comparação com outros centros de referência, como o Texas Heart Institute (USA), a técnica de tratamento cirúrgica aplicada no HSI demonstrou-se segura, sem mortalidade e com resultados a médio prazo adequados e compatíveis com a literatura.

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Section: Resultsunclassified

Section: Introductionunclassified

Interrupção do Arco Aórtico: Tratamento Cirúrgico no Adulto em um Centro de Referência de Cardiopatia

Rocha¹,

Wanderley²,

Costa³

2020

RCHSI

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“…Anatomic resemblance of coarctation with type A IAA makes these two entities a part of a continuum with isolated IAA being an extreme form of coarctation. 5 In isolated IAA (without associated cardiac anomalies), patient survival is longer because of effective collateralization, similar to coarctation of aorta. 4 All the reported adult cases in literature belong to type A as in our case.…”

Section: Discussionmentioning

confidence: 99%

Ruptured cerebral aneurysm in isolated type A interrupted aortic arch managed by transradial endovascular route: A case report with literature review

et al. 2022

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Background and Introduction Interrupted aortic arch (IAA) is a very rare congenital anomaly carrying high neonatal mortality rate if left untreated. Rarer still, is its presentation in teenage or adulthood. This condition has been found to be complicated with cerebral aneurysms, which is a consequence of hemodynamic stress and hypertension secondary to arch interruption. Cerebral aneurysms can further complicate the clinical course and lead to poor clinical outcomes, especially if ruptured. Clinical Presentation A 17-year-old female presented with ruptured basilar top aneurysm and was considered for endovascular coiling. Transfemoral access was chosen but the catheter could not be negotiated beyond proximal thoracic aorta. A computed tomographic angiography (CTA) of thorax and abdomen was performed, which showed isolated interruption of aortic arch. Subsequently, transradial route was used for coiling of the aneurysm. Conclusion To the best of our knowledge, the index case is one of the only seven cases of IAA with cerebral aneurysm that have been reported till date in medical literature. It also holds the unique distinction of being the first case of IAA with cerebral aneurysm treated by endovascular approach. Our case highlights the importance of transradial access in such pathological conditions.

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“…According to the location of the dissection, it is divided into three types[ 2 ]: The dissection located at the distal to the left subclavian artery origin (type A); that located between the left common carotid artery and the left subclavian artery (type B); and that between the brachiocephalic trunk and the left common carotid artery (type C). Type A accounts for approximately 79% of adult IAA cases[ 3 ], without the complications associated with type B such as ventricular septal defects and patent ductus arteriosus[ 1 , 4 - 6 ]. Coarctation of the aorta (CoA) is defined as a discrete stenosis of the aorta usually located in the area of the ligamentum arteriosum, with a higher incidence of 6%-8% than IAA[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Difference and similarity between type A interrupted aortic arch and aortic coarctation in adults: Two case reports

Ren¹,

Zhang²,

Li³

et al. 2022

WJCC

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

Cited by 3 publications

References 20 publications

Interrupção do Arco Aórtico: Tratamento Cirúrgico no Adulto em um Centro de Referência de Cardiopatia

Interrupção do Arco Aórtico: Tratamento Cirúrgico no Adulto em um Centro de Referência de Cardiopatia

Ruptured cerebral aneurysm in isolated type A interrupted aortic arch managed by transradial endovascular route: A case report with literature review

Difference and similarity between type A interrupted aortic arch and aortic coarctation in adults: Two case reports

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