Magnetic Resonance Angiography of a Congenitally Interrupted Aortic Arch
A 26-year-old man presented with sudden onset headache, loss of consciousness, neck stiffness, and visual impairment. An urgent computed tomographic scan showed a diffuse subarachnoid hemorrhage, which was treated with a right frontal craniotomy and clipping of a right anterior communicating artery aneurysm (Figure 1). An arch aortogram performed during the preoperative neurosurgical evaluation revealed a complete interruption of the aortic arch just distal to the origin of the left subclavian artery (Figure 2). This was associated with an ejection systolic murmur, marked upper limb hypertension, impalpable femoral pulses, and rib notching on chest radiograph. Transthoracic echocardiography demonstrated concentric left ventricular hypertrophy with good left ventricular function. In addition, suprasternal views showed that the descending aorta appeared to terminate immediately after the left subclavian artery. A gadolinium contrast-enhanced magnetic resonance angiogram (MRA) was performed later to clarify the aortic anatomy and to assess the collateral circulation before definitive repair. The MRA clearly reaffirmed a complete interruption of the descending aorta 1.7 cm from the left subclavian artery with extensive collaterization (Figure 3). The ascending aortic root was mildly dilated to 3.5 cm. The patient has been scheduled for elective surgical repair.
This case shows the clinical value of MRA for noninvasive assessment of congenital anomalies of the aortic arch.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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