Circulation. 2006;113:e863-e865
doi: 10.1161/CIRCULATIONAHA.104.459727
(Circulation. 2006;113:e863-e865.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Interrupted Aortic Arch With Bilateral Ductus Arteriosi and Bilateral Aberrant Subclavian Arteries
Jeremy D. Asnes, MD;
Jacobo Kirsch, MD;
Richard D. White, MD;
Brian Duncan, MD
From Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, Conn (J.D.A.), and Departments of Diagnostic Radiology (J.K.) and Cardiovascular Imaging (R.D.W.) and The Center for Pediatric and Congenital Heart Diseases (B.D.), The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Jeremy D. Asnes, MD, Section of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064. E-mail asnesj{at}ccf.org
A newborn infant presented with tachypnea, cyanosis, and diminished pulses in all extremities. An initial echocardiogram suggested an interrupted aortic arch (type B) with aberrant left subclavian artery, restrictive left sided patent ductus arteriosus, and a right-sided descending thoracic aorta. The aortic valve was bicommissural (6 mm annulus). There was a large conal septal ventriculoseptal defect and a secundum atrial septal defect. Intravenous prostaglandin E1 was initiated, and bounding pulses returned in all extremities. A contrast-enhanced helical computed tomography scan (Figure 1A and 1B) demonstrated interrupted aortic arch type B with a small ascending aorta giving rise to the left and right common carotid arteries, and bilateral patent ductus arteriosi arising from the main pulmonary artery and coalescing with a right-sided descending thoracic aorta posterior to the trachea and esophagus. The left and right subclavian arteries arose from their respective distal ductal arches just proximal to their convergence with the descending aorta. Chromosome 22q11 deletion was found. This anatomy was confirmed intraoperatively (Figure 2). The left ductal arch was transected. The distal left ductal arch adjacent to the descending aorta was over-sewn. The ascending aorta was opened on its posterior surface, and the right ductal arch was transected just proximal to the right subclavian artery. The descending aorta and right subclavian artery were anastomosed to the ascending aortotomy. The left subclavian artery was anastomosed end-to-side to the left carotid artery (Figure 3A and 3B). The atrial and ventricular septal defects were closed. There were no hemodynamically significant residual lesions.
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Figure 1. Volume-rendered reconstruction of preoperative anatomy. A, Right anterior oblique view showing main pulmonary artery (MPA), ascending aorta (aAo), right pulmonary artery (RPA), left pulmonary artery (LPA), right ductus (RDuct), left ductus (LDuct), right common carotid (RCC), and left common carotid (LCC). B, Posterior view showing LDuct, Rduct, descending aorta (dAo), left subclavian artery (LSCA), right subclavian artery (RSCA), RPA, and LPA.
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Figure 2. Intraoperative photograph showing exposure of MPA, aAo, RPA, RDuct, LDuct, trachea (Trach), LCC, and right atrial appendage (RAA) via median sternotomy.
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Figure 3. Volume-rendered reconstruction of postoperative anatomy. A, Left anterior oblique view showing aAo, LCC, RCA, RSCA arising from the right neo-aortic arch distal to the RCA, and LSCA arising from the LCC. B, Right posterior oblique view showing residual stump of left ductal arch (LDS).
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Acknowledgments
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Disclosures
None.
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Footnotes
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The online-only Data Supplement, which contains a movie, can be found at http://circ.ahajournals.org/cgi/content/full/113/24/e863/DC1.
