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Review
. 2002;29(2):118-21.

Interrupted aortic arch in an adult single-stage extra-anatomic repair

Greg Messner  1 , George J Reul, Scott D Flamm, Igor D Gregoric, Ulrich Tim Opfermann
Affiliations
Review

Interrupted aortic arch in an adult single-stage extra-anatomic repair

Greg Messner et al. Tex Heart Inst J. 2002.

Abstract

Interrupted aortic arch is a rare congenital malformation of the aortic arch that occurs in 3 per million live births. Defined as a loss of luminal continuity between the ascending and descending portions of the aorta, this anomaly entails a very poor prognosis without surgical treatment. To our knowledge, the world medical literature contains only 12 reports of isolated interrupted aortic arch diagnosed in adults. Nine of these patients underwent successful surgical repair, but 1 died during the early postoperative period. We describe a 10th successful surgical repair, which involved a 42-year-old woman who had an asymptomatic type B interrupted aortic arch (characterized by interruption between the left subclavian and left carotid arteries). We performed a single-stage extra-anatomic repair by placing a 16-mm extra-anatomic Dacron graft between the ascending and descending portions of the thoracic aorta and by interposing a 7-mm extra-anatomic Dacron graft between the 16-mm graft and the left subclavian artery. The patient recovered uneventfully and continued to do well 6 months later.

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Figures

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Fig. 1 Preoperative, contrast-enhanced, 3-dimensional, magnetic resonance angiogram (lateral view) reveals severe hypoplasia of the transverse aortic arch (arrow) between the origins of the left common carotid and left subclavian arteries (interrupted aortic arch, type B). Extensive collateral vessels are evident in the paraspinal region (arrowheads) and involve the vertebrobasilar system (asterisk). The dark gray areas show vessels with antegrade flow, and the light gray areas denote those with retrograde flow.
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Fig. 2 Intraoperative photograph shows the distal end of the 7-mm graft, which has been anastomosed end-to-side to the proximal end of the 16-mm graft.
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Fig. 3 Postoperative, contrast-enhanced, 3-dimensional, magnetic resonance angiograms. A) The lateral view reveals severe hypoplasia of the transverse arch, as in Figure 1. However, the patient now has 2 grafts: the larger, 16-mm graft (arrowhead) is anastomosed end-to-side to the mid-portion of the ascending aorta and to the distal portion of the descending thoracic aorta. B) The shallow left anterior oblique projection shows the smaller, 7-mm graft (arrows), which has been sutured end-to-side to the proximal 16-mm graft and to the left subclavian artery.
See this image and copyright information in PMC

References

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