Isolated Interrupted Aortic Arch: A Case Report and Review of the Literature

Akdemir, Ramazan; Özhan, Hakan; Erbilen, Enver; Yazıcı, Mehmet; Gündüz, Hüseyin; Uyan, Ci̇hangi̇r

doi:10.1023/b:caim.0000041940.14780.1c

Cited by 27 publications

(25 citation statements)

References 6 publications

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“…Successful implantation was performed by consecutive balloon inflation using nominal pressures. The pressure gradient dropped to 5 mm Hg, and final angiography showed excellent results [5].…”

Section: Methodsmentioning

confidence: 91%

“…However, re-intervention rates are higher in PTA and stenting than surgery [2][3][4][5][6][7][8][9][10]. Treatment should be performed shortly after establishment of the diagnosis to avoid possible late complications such as congestive heart failure, death, and hypertension-related events [14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that balloon angioplasty (BAP) and stenting have similar procedural success and early and late complications in CoA [3,4]. The immediate improvement in hypertension and morbidity were similar across all groups [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Native aortic coarctation stenting in adults and adolescents: early and mid-term results of an adult interventional cardiology team

Akdemir¹,

Gunduz²,

Murat³

et al. 2012

pwki

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A b s t r a c tBackground: Stent implantation has evolved as an important therapeutic strategy for aortic coarctation. Aim: This study aimed to present the experience of aortic coarctation stenting using the Cheatham-Platinum stent by an Adult Interventional Cardiology Team.Material and methods: The data of 11 patients (ages were between 15 to 58 years) who underwent aortic coarctation stent implantation between 2008 and 2011 for moderate to severe native aortic coarctation were retrospectively collected.Results: Average systolic blood pressure was 175 ±35 mm Hg, and mean diastolic blood pressure was 115 ±15 mm Hg. Pressure gradient proximal and distal to aortic coarctation was 55.5 ±17.7 before the stenting. The invasive gradient decreased below 10 mm Hg in all patients. There were no complications except in one patient whose subclavian artery was occluded without any clinical finding. One patient had a totally occluded lesion, needing perforation for acquired interruption using a 0.35 inch hydrophilic wire under the supporting balloon. There was no aneurysm or restenosis at follow-up. Left ventricular functions completely recovered within 1 month in all patients.Conclusions: Stenting using the Cheatham-Platinum stent, either covered or bare, is safe in moderate to severe native aortic coarctation and provides an excellent transcoarctation gradient and clinical hypertension and left ventricular functional relief in adult patients.Key words: aortic coarctation, angioplasty, Cheatham-Platinum stent S t r e s z c z e n i e Wstęp: Implantacja stentu stała się ważną metodą leczenia koarktacji aorty. Cel: Celem badania było przedstawienie doświadczenia zespołu interwencyjnego leczenia kardiologicznego dorosłych w stentowaniu koarktacji aorty z użyciem stentu Cheatham-Platinum.Materiał i metody: Dokonano retrospektywnej analizy danych 11 pacjentów (w wieku 11-58 lat), u których wykonano implantację stentu w miejsce koarktacji aorty. Zabiegi przeprowadzono pomiędzy 2008 a 2011 rokiem u pacjentów z natywną koarktacją aorty w stopniu od umiarkowanego do ciężkiego.Wyniki: Średnia wartość skurczowego ciśnienia tętniczego wynosiła 175 ±35 mm Hg, a średnie ciśnienie rozkurczowe 115 ±15 mm Hg. Przed zabiegiem wszczepienia stentu gradient ciśnienia pomiędzy miejscem proksymalnie i dystalnie do koarktacji aorty wynosił 55,5 ±17,7 mm Hg. U wszystkich pacjentów osiągnięto spadek gradientu w pomiarze inwazyjnym do wartości poniżej 10 mm Hg. U jednego pacjenta doszło do zamknięcia tętnicy podobojczykowej bez innych klinicznych następstw. Poza tym nie wystąpiły inne

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Section: Methodsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Native aortic coarctation stenting in adults and adolescents: early and mid-term results of an adult interventional cardiology team

Akdemir¹,

Gunduz²,

Murat³

et al. 2012

pwki

Self Cite

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“…Although it has some limitations, echocardiography is the procedure of choice for the initial diagnosis of IAA in almost all cases. [6] Cardiac catheterization is the most widely used technique for the definitive diagnosis; however, it may be difficult to perform this in patients without a prior knowledge of their vascular anatomy to ensure visualization of both the proximal and distal segments. [7] In the presented case, aortography via brachial artery demonstrated the IAA, the site of interruption, and the branching pattern of the great arteries.…”

Section: Discussionmentioning

confidence: 99%

The single-stage extra-anatomic repair of an isolated interrupted aortic arch in an adult and a review of the literature

Özeren¹

2012

Turk Gogus Kalp Dama

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Kesintiye uğramış arkus aort, çıkan ve inen aort arasında lümenin tamamen kaybı ve anatomik sürekliliğin olmaması ile karakterize, nadir ve ciddi bir doğuştan kalp defektidir. Bu malformasyonun prognozu, cerrahi olarak tedavi edilmez ise kötüdür. Bu yazıda tip A kesintiye uğramış arkus aortu olan ve cerrahi ile başarılı bir şekilde tedavi edilen 56 yaşında erkek hasta, konu ile ilgili literatür göz-den geçirilerek sunuldu.Anah tar söz cük ler: Erişkin; doğuştan; ekstra anatomik baypas; kesintiye uğramış arkus aort.Interrupted aortic arch is a rare and severe congenital heart defect characterized by a complete loss of luminal and anatomic continuity between the ascending and the descending aorta. This malformation has a poor prognosis without surgical treatment. In this article, we present a 56-year-old male patient with interrupted aortic arch type A who was treated successfully with surgery, and review the literature regarding this topic.Key words: Adult; congenital; extra-anatomic bypass; interrupted aortic arch.The interruption of the aortic arch (IAA) characterized by complete luminal and anatomic discontinuity between the ascending and descending aorta is an extremely rare entity in the adult population.[1] It is often diagnosed and repaired during the neonatal period. The prognosis for this anomaly depends on the associated congenital anomalies, but the outcome is usually very poor unless there is surgical treatment. We found 18 adult cases (18 years and older) of IAA which had been surgically treated by extra-anatomic bypass in the literature. Herein we describe a successful extra-anatomic repair in a patient who had an isolated type A aortic interruption. CASE REPORTA 56-year-old male patient arrived at the cardiology clinic of our hospital complaining of chest pain and shortness of breath. He also had a history of stroke due to an intracranial hemorrhage and hypertension, which had been treated with angiotensin-converting enzyme (ACE) inhibitors. On his physical examination, the peripheral pulses were normally palpable in the upper extremities, but they were reduced in the lower limbs. Cardiac auscultation revealed a rhythmic tachycardia with no additional heart sounds. Electrocardiography showed sinus tachycardia and signs of left ventricular hypertrophy and ST-T wave changes. Chest radiography showed an increased cardiothoracic ratio. Laboratory results were within normal ranges.An angiography was performed via the femoral approach for coronary artery imaging, but the catheter could not be inserted to the arcus aorta (Figure 1a). Interruption of the thoracic aorta was suspected. The angiography was then repeated via the brachial approach, and the interruption of the arcus aorta was diagnosed with normal coronary arteries (Figure 1b). An angiotomography of the aorta was then requested which disclosed an aortic occlusion 2 cm after the origin of the left subclavian artery (Figure 2a). This

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“…The most frequently described surgical approach in adults is extra-anatomic, in preparation for a single-stage repair. 8,9 A thorough search of the published literature showed few IAA patients over 60 years of age (Table I 10-16 ). In one report, a 59-year-old man with severe aortic valve stenosis and IAA underwent surgical correction.…”

Section: Texas Heart Institute Journalmentioning

confidence: 99%

Asymptomatic Interrupted Aortic Arch, Severe Tricuspid Regurgitation, and Bicuspid Aortic Valve in a 76-Year-Old Woman

Tajdini¹,

Sardari²,

Forouzannia³

et al. 2016

Texas Heart Institute Journal

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I nterrupted aortic arch (IAA) is a rare congenital abnormality (incidence rate, 3 per million live births per annum). Loss of luminal continuity between the ascending and descending portions of the aorta is the main pathologic condition.1 Some cardiac malformations-including patent ductus arteriosus, ventricular septal defect, bicuspid aortic valve (BAV), left ventricular (LV) outflow tract obstruction, and aortopulmonary window-have customarily been associated with IAA.2 On the basis of the site of the lesion, 3 types of disease have been reported. In type A, arch interruption occurs distal to the origin of the left subclavian artery (this is also known as interruption at the aortic isthmus). In type B, the lesion is distal to the origin of the left common carotid artery; and in type C, the interruption is between the common carotid arteries.3 Because of the high mortality rate-75% by 10 days and 90% at 12 months of life (without surgical correction in infancy)-IAA is very rare among adults. 2,3 In this report, we describe the case of a 76-year-old woman with asymptomatic IAA, severe tricuspid regurgitation (TR), and BAV, a perhaps unique combination of pathologic conditions that no one, to our knowledge, has reported before. Case ReportIn August 2014, a 76-year-old woman was referred to our department for dyspnea on exertion (New York Heart Association functional class II), which had begun one month before referral. No other relevant information was found in her medical history. Upon physical examination, her peripheral pulses were palpable symmetrically, over the carotid arteries and in the upper limbs. We heard a machine-like murmur over the right scapula and a soft systolic murmur over the left sternal border space. Lower-limb pulses were not palpable. Chest radiographs revealed no pathologic abnormalities. An electrocardiogram showed sinus rhythm and right bundle branch block.Transthoracic echocardiography revealed a normal LV ejection fraction (0.55), severe right ventricular dysfunction, BAV, mild aortic valve regurgitation, and severe tricuspid valve regurgitation (pulmonary artery pressure, 40 mmHg). Coronary angiography was performed via a right radial artery approach. The left anterior descending artery and the right coronary artery had significant stenoses. Aortography showed enlargement of the ascending aorta, BAV, normal aortic arch dimensions, and occlusion of the aorta immediately distal to the origin of the left subclavian artery (Fig. 1). Computed tomographic (CT) angiographic findings were compatible

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Isolated Interrupted Aortic Arch: A Case Report and Review of the Literature

Cited by 27 publications

References 6 publications

Native aortic coarctation stenting in adults and adolescents: early and mid-term results of an adult interventional cardiology team

Native aortic coarctation stenting in adults and adolescents: early and mid-term results of an adult interventional cardiology team

The single-stage extra-anatomic repair of an isolated interrupted aortic arch in an adult and a review of the literature

Asymptomatic Interrupted Aortic Arch, Severe Tricuspid Regurgitation, and Bicuspid Aortic Valve in a 76-Year-Old Woman

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