Interrupted aortic arch associated with aortopulmonary window in a 20 year-old young adult

Interrupted Aortic Arch in the Adult

“…The management of IAA in the adult appears to be the same as in infants: surgical repair, by either bypass or percutaneous stent placement. Surgical correction with sternotomy or lateral thoracotomy was performed in the majority (54%) with an additional 27% receiving an unknown surgical intervention; 8% received percutaneous wire perforation and subsequent stent placement through the septum dividing the ascending and descending aorta, 8 and 10% were managed medically after refusal of surgical management 13,17,28,31 . One case series suggests a sternotomy and upper midline laparotomy because of well‐developed collateral and intercostal vessels and subsequent risk of bleeding if thoracotomy was employed 3 .…”

“…Percutaneous wire perforation of the septum with dilation and stent placement within the aorta was performed in three patients 8,28 . Kusa et al state that their patient had a known coarctation of the aorta as a child and had been medically managed for years; it was his choice not to undergo surgery and instead opted for a less‐invasive approach.…”

“…The author cautions that the stent placement was possible in this case as the aortic wall was known to be intact between the segments, and the interruption was known to be the end‐result of a progressively narrowed aortic coarctation (which can been successfully treated with stent placement and dilation). He also cautions that immediate access to cardiac surgery must be available in case of an emergency 28 …”

Hybrid intervention for type A aortic arch interruption and a giant subclavian artery aneurysm in an adult

“…6 Isolated aortic arch interruption without a patent ductus arteriosus or aortopulmonary window is considered as a fatal condition during early stages of life. 2 In the pathophysiology of isolated interrupted aortic arch in adulthood, a well-developed collateral circulation is necessary to enable survival. The presentation ranges from lack of symptoms to limb swelling with differential blood pressures in all extremities; however, collateral vessels may be subject to atrophy and atherosclerosis, which lead to other challenging problems such as rupture and bleeding.…”

“…It is a very rare congenital malformation in young adults. [2][3][4] Technically, conventional repair with end-to-end anastomosis through thoracotomy incision is a surgical challenge because of the extensive collateral circulation on the chest wall. Aortic repair through a mid-line sternotomy is an alternative to avoid injury to collateral vessels.…”