Ann Thorac Surg 2011;91:615. doi:10.1016/j.athoracsur.2010.06.037
© 2011 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Aortic Arch Interruption With Thoracic Aortic Dissection
Jiayi Li, MD,
Minwen Zheng, MD*
Department of Cardiology and Radiology, Xijing Hospital, the Fourth Military Medical University, Xian, China
* Address correspondence to Dr Zheng, Department of Radiology, Xijing Hospital, 15# West Changle Rd, Xian, 710032 China (Email: zhengmw2007{at}yahoo.com.cn).
A 37-year-old man presented with a 2-week history of tearing chest and back pain. He was asymptomatic until 25 years of age. After that he had worsening symptoms develop, including headache, dizziness, blurred vision, and feet weakness. On examination, there was a bounding carotid pulse in his right neck. The blood pressure was 190/100 mm Hg in his right arm, but it was not detectable in his left arm or either leg. An echocardiogram showed a dilated left atrium and ventricle with a thickened interventricular septum, but no intracardiac anomalies were detected. He was referred to a 16-slice computed tomographic angiography and the diagnosis was ultimately confirmed.
Three-dimensional volume-rendering image (Fig 1A) and oblique coronary maximum-intensity projection image (Fig 1B) demonstrated the occlusion of the aortic arch with a tapered stump (white arrow). Ascending aorta (AAO), innominate artery (IA), right subclavian artery, and right internal mammary artery were all dilated. Three-dimensional volume-rendering image (Fig 2A) showed the left subclavian artery (LSA) was connected to the descending aorta (DAO). Left common carotid artery and vertebral artery failed to display, and there was massive collateral vessel formation (white arrow) in the left neck. Local dilation and intimal flap (black arrow) were observed at the upper segment of DAO. Thin oblique coronary maximum-intensity projection image (Fig 2B) also demonstrated the local dissection of DAO. The intimal flap tearing was involved with the upper segment of DAO and LSA (white arrow).
Isolated aortic arch interruption is a rare congenital cardiovascular malformation, especially in an adult survivor. We believe that this is the first report of isolated aortic arch interruption with a complicating descending thoracic aortic dissection.
