Ann Thorac Surg 2007;84:299
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Pre-Surgical Evaluation of Interrupted Aortic Arch With 3-Dimensional Reconstruction of CT Images
Jill Morriss, MDa,*,
Jessica Moreland, MDa,
Harold Burkhart, MDb,
Simon Kao, MDc
a Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
b Department of Cardiothoracic Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
c Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
* Address correspondence to Dr Morriss, University of Iowa Hospitals & Clinics, Division of Pediatric Cardiology, 200 Hawkins Dr, Iowa City, IA 52242-1083 (Email: j-morriss{at}uiowa.edu).
Two unusual variants of interrupted aortic arch are seen in the images herein. Precision of anatomic display using 3-dimensional reconstruction of preoperative computed tomographic (CT) scans with contrast were superior to echocardiographic images in each of these 2-day-old girls, and optimized surgical planning. The interrupted aortic arch (type B) with origin of the left subclavian artery relatively distal to the connection of the ductus to the descending thoracic is evident in Figure 1, a 3-dimensional reconstruction of CT scans with contrast in a patient with IAA type B; interruption between the left carotid (LCA) and left subclavian arteries (LSC). (Fig 1A: anterior view with right innominate artery [INN] as the first arch vessel with arch interruption distal to the origin of the left carotid artery [LCA]; Fig 1B: posterior view demonstrates the remote origin of the left subclavian artery [LSA] arising below the interruption and supplied by ductal flow from the pulmonary artery). Figure 2
displays unanticipated extreme foreshortening of the ascending aorta with immediate branching into two carotid arteries (Fig 2A: anterior view displays extreme malformation of the ascending aorta which bifurcates into the right carotid artery [RCA] and the left carotid artery [LCA] at a level well inferior to that of main pulmonary artery branching). No innominate vessel is identified (Fig 2B: posterior view displays the LSC origin below the interruption and a fourth arch vessel identified to be an aberrant right subclavian artery [RSC]). By suturing the carotids together, the surgeon extended the length of the proximal aorta before the mobilized descending aorta could be connected to it.
