Isolated interrupted of aortic arch diagnosed using CT angiography

Chen, Guangwen; Li, Hang; Pu, Hong

doi:10.1097/md.0000000000010569

Cited by 11 publications

(12 citation statements)

References 9 publications

(9 reference statements)

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“…Interrupted aortic arch is a life-threatening congenital cardiovascular malformation with an incidence of 3 per million live Mortality occurred on the post-operative 3rd day due to cardio-septic shock births 2 and rarely occurs as an isolated lesion. 5,8 Ventricular septal defect is the most common concomitant anomaly in these patients that is seen in 73% of the cases. The patent ductus arteriosus has to continue as descending aorta otherwise lower body perfusion is compromised.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, the main factor of the survival is the extensive collateral vessels that provide distal blood flow. 8 In the neonatal period, the pathology is associated with severe congestive heart failure or lower body hypoperfusion, severe metabolic acidosis and multi-organ failure with the ductal closure. 1,3 The mortality in the first days of life is generally due to the closure of the patent ductus arteriosus; and without treatment, 90% of the patients die at a median age of 4 days.…”

Section: Discussionmentioning

confidence: 99%

“…3,5 The physical examination may reveal differential cyanosis and the gradient between lower and upper peripheral pulses in neonates 3,4 which are clues for either aortic interruption or coarctation which may be confirmed with transthoracic echocardiography, initially. 8 CT angiography and MRI may also be used in challenging cases to confirm the exact pathology regarding the aortic arch and differential diagnosis between aortic coarctation, interrupted aortic arch and the exact type location of the stenosis/interruption at the aortic arch. 8 Although in the preoperative period, prostaglandin E1 infusion is vital for the survival to provide ductal patency, 1 early surgical therapy is the main treatment option for the babies with interrupted aortic arch.…”

Section: Discussionmentioning

confidence: 99%

“…8 CT angiography and MRI may also be used in challenging cases to confirm the exact pathology regarding the aortic arch and differential diagnosis between aortic coarctation, interrupted aortic arch and the exact type location of the stenosis/interruption at the aortic arch. 8 Although in the preoperative period, prostaglandin E1 infusion is vital for the survival to provide ductal patency, 1 early surgical therapy is the main treatment option for the babies with interrupted aortic arch. 3,8 Endovascular treatment may be considered when two parts of the aorta are very close or only separated with a membrane, 5,12 treatment methods include end-to-end or end-toside direct anastomosis, graft interposition 8 and extra-anatomic bypass using a graft.…”

Section: Discussionmentioning

confidence: 99%

“…8 Although in the preoperative period, prostaglandin E1 infusion is vital for the survival to provide ductal patency, 1 early surgical therapy is the main treatment option for the babies with interrupted aortic arch. 3,8 Endovascular treatment may be considered when two parts of the aorta are very close or only separated with a membrane, 5,12 treatment methods include end-to-end or end-toside direct anastomosis, graft interposition 8 and extra-anatomic bypass using a graft. 2 End-to-end direct anastomosis or extended aortic arch anastomosis are the most common and relatively the most anatomical surgical techniques; however, direct anastomosis may cause stenosis and/or bronchial compression.…”

Section: Discussionmentioning

confidence: 99%

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Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

et al. 2020

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Aim: Standard surgical treatment of the interrupted aortic arch with the use of cardiopulmonary bypass is risky especially in critically ill babies. In this manuscript, we present the results of off-pump pericardial roll bypass for the treatment of aortic interruption. Material and methods: The technique was applied in nine critically ill infants between July 2011 and December 2019. Data were reviewed retrospectively. There were four girls and five boys. The types of the interruption were type B in six cases and type A in three babies. Additional cardiovascular anomalies were ventricular septal defect in all, atrial septal defect or patent foramen ovale in all, single-ventricle pathologies in two and bicuspid aortic valve in three cases. All the patients were in critical situations such as intubated, having symptoms of infection, congestive heart failure or ischaemia and malperfusion leading visceral organ dysfunction. Results: All patients underwent off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll. Post-operative early mortality occurred in one patient with severe mitral regurgitation due to cardio-septic shock. One patient who had single-ventricle pathology underwent bidirectional Glenn and was lost on the post-operative 26th day due to sepsis 2 years after operation. Two patients presented with dilatation of the pericardial tube 18 and 24 months after the operations and one underwent reconstruction of the neo-arch. The remaining patients are asymptomatic, active and within normal limits of body and mental growth. Conclusion: Treatment of interrupted aortic arch with a bypass with an autologous pericardial roll treated with gluteraldehyde without cardiopulmonary bypass seems a safe and reliable technique especially for the treatment of critically ill infants.

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Section: Discussionmentioning

confidence: 99%