Interrupted aortic arch detected 4 days after surgical ventricular septal defect and patent ductus arteriosus closure: a case report

Pribadi Wiranda Busro; Indriwanto Sakidjan; Fathy Zuandi Pohan; Ameru Ulfalian; Chaidar Muttaqin; Hari Agung Asari

doi:10.15562/bmj.v12i1.3836

Interrupted aortic arch detected 4 days after surgical ventricular septal defect and patent ductus arteriosus closure: a case report

Pribadi Wiranda Busro ,

Indriwanto Sakidjan ,

Fathy Zuandi Pohan ,

Ameru Ulfalian ,

Chaidar Muttaqin ,

Hari Agung Asari ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i1.3836 |
Published: 2023-02-20

Abstract

Background: Interrupted aortic arch is a loss of luminal continuity between ascending and descending aorta. In a patient with an interrupted aortic arch, systemic perfusion is supplied by ductus arteriosus. Therefore, ductal closure will lead to systemic hypoperfusion. We present a case of undiagnosed type A interrupted aortic arch on initial examination.

Case Presentation: A 4-month-old patient had signs of systemic hypoperfusion after a successful surgical ventricular septal defect and patent ductus arteriosus closure. Blood pressure between the upper and lower extremities showed a wide discrepancy. Echocardiography showed no flow from the aortic arch to the descending aorta. Emergency re-operation was performed, and type A interrupted aortic arch was found with descending aorta connected to the pulmonary artery. The interrupted aortic arch repair was performed using end to side technique. The patient was discharged on a post-operative day 26 without any complication, and no abnormalities were found on a 3-month follow-up.

Conclusion: Careful physical examination, including BP measurement of all extremities, is warranted. To avoid misdiagnosis, preoperative echocardiography must be performed thoroughly to assess cardiac and great vessel abnormalities, including color flow Doppler.

References

Kosucu P, Kosucu M, Dinc H, Korkmaz L. Interrupted aortic arch in a adult: diagnosis with MSCT. Int J Cardiovasc Imaging. 2006;22(5):735-739.
Mishra PK. Management strategies for interrupted aortic arch with associated anomalies. Eur J Cardiothorac Surg. 2009;35(4):569-576.
Rogelio V, Oglietti J, Wukasch DC, Hallman GL, Cooley DA. Interruption of aortic arch surgical considerations. J Thorac Cardiovasc Surg. 1976;72(2):235-242.
Reardon MJ, Hallman GL, Cooley DA. Interrupted aortic arch: brief review and summary of an eighteen-year experience. Tex Heart Inst J. 1984;11(3):250-259.
Roberts WC, Morrow AG, Braunwald E. Complete interruption of aortic arch. Circulation. 1962;26(1):39-59.
Jonas RA. Interrupted aortic arch. In: pediatric cardiac surgery, 4th ed. West Sussex: Wiley-Blackwell. 2013.
Kaulitz R, Jonas RA, van der Velde ME. Echocardiographic assessment of interrupted aortic arch. Cardiol Young. 1999;9(6):562-571.
Sari I, Davutoglu V, Soydinc S, Ozer O. A case of misdiagnosed interrupted aortic arch as primary hypertension for almost two decades. N Z Med J. 2007;120(1258):U2635.
Ponte M, Dias A, Ferreira ND, Fonseca C, Mota JC, Gama V. Interrupted aortic arch: A misdiagnosed cause of hypertension. Rev Port Cardiol. 2014;33(6):389.e1-5.
Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease. Circulation. 2014;129(21):2183-2242.
Everts-Suarez EA, Carson CP. The triad of congenital absence of aortic arch (isthmus aortae), patent ductus arteriosus and interventricular septal defect – a trilogy. Ann Surg.1959;150(1):153-159.
McCrindle BW, Tchervenkov CI, Konstantinov IE, Williams WG, Neirotti RA, Jacobs ML, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg. 2005;129(2):343–350.
Park MK. Park’s pediatric cardiology for practitioners, 6th ed. Philadelphia: Elsevier Saunders. 2014.
Huhta JC, Gutgesell HP, Latson LA, Huffines FD. Two-dimensional echocardiographic assessment of the aorta in infants and children with congenital heart disease. Circulation. 1984;70(3):417-424.
Dillman JR, Yarram SG, D’Amico AR, Hernandez RJ. Interruped aortic arch: spectrum of MRI findings. AJR. 2008;190(6):1467-1474.
Manuaba AIBP, Dewi NGAPLS, Prabawa IPY, Bhargah A, Wu CC. Virtual patient simulation method for learning and assessment in cardiology field. Bali Medical Journal. 2020;9(3):553-556.

[1] Kosucu P, Kosucu M, Dinc H, Korkmaz L. Interrupted aortic arch in a adult: diagnosis with MSCT. Int J Cardiovasc Imaging. 2006;22(5):735-739.

[2] Mishra PK. Management strategies for interrupted aortic arch with associated anomalies. Eur J Cardiothorac Surg. 2009;35(4):569-576.

[3] Rogelio V, Oglietti J, Wukasch DC, Hallman GL, Cooley DA. Interruption of aortic arch surgical considerations. J Thorac Cardiovasc Surg. 1976;72(2):235-242.

[4] Reardon MJ, Hallman GL, Cooley DA. Interrupted aortic arch: brief review and summary of an eighteen-year experience. Tex Heart Inst J. 1984;11(3):250-259.

[5] Roberts WC, Morrow AG, Braunwald E. Complete interruption of aortic arch. Circulation. 1962;26(1):39-59.

[6] Jonas RA. Interrupted aortic arch. In: pediatric cardiac surgery, 4th ed. West Sussex: Wiley-Blackwell. 2013.

[7] Kaulitz R, Jonas RA, van der Velde ME. Echocardiographic assessment of interrupted aortic arch. Cardiol Young. 1999;9(6):562-571.

[8] Sari I, Davutoglu V, Soydinc S, Ozer O. A case of misdiagnosed interrupted aortic arch as primary hypertension for almost two decades. N Z Med J. 2007;120(1258):U2635.

[9] Ponte M, Dias A, Ferreira ND, Fonseca C, Mota JC, Gama V. Interrupted aortic arch: A misdiagnosed cause of hypertension. Rev Port Cardiol. 2014;33(6):389.e1-5.

[10] Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease. Circulation. 2014;129(21):2183-2242.

[11] Everts-Suarez EA, Carson CP. The triad of congenital absence of aortic arch (isthmus aortae), patent ductus arteriosus and interventricular septal defect – a trilogy. Ann Surg.1959;150(1):153-159.

[12] McCrindle BW, Tchervenkov CI, Konstantinov IE, Williams WG, Neirotti RA, Jacobs ML, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg. 2005;129(2):343–350.

[13] Park MK. Park’s pediatric cardiology for practitioners, 6th ed. Philadelphia: Elsevier Saunders. 2014.

[14] Huhta JC, Gutgesell HP, Latson LA, Huffines FD. Two-dimensional echocardiographic assessment of the aorta in infants and children with congenital heart disease. Circulation. 1984;70(3):417-424.

[15] Dillman JR, Yarram SG, D’Amico AR, Hernandez RJ. Interruped aortic arch: spectrum of MRI findings. AJR. 2008;190(6):1467-1474.

[16] Manuaba AIBP, Dewi NGAPLS, Prabawa IPY, Bhargah A, Wu CC. Virtual patient simulation method for learning and assessment in cardiology field. Bali Medical Journal. 2020;9(3):553-556.

Interrupted aortic arch detected 4 days after surgical ventricular septal defect and patent ductus arteriosus closure: a case report

Abstract

References

How to Cite

Search Panel