Percutaneous Therapy of Functional Interrupted Aortic Arch with 3-1 Dimensional Printing Guidance

Case Report

Austin J Clin Cardiolog. 2022; 8(3): 1097.

Percutaneous Therapy of Functional Interrupted Aortic Arch with 3-1 Dimensional Printing Guidance

Mao Y, Li L, Zhai M, Ma Y, Jin P, Liu Y* and Yang J*

Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China

*Corresponding author: Jian Yang, Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi’an 710032, Shaanxi, China

Yang Liu, Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi’an 710032, Shaanxi, China

Received: September 02, 2022; Accepted: October 06, 2022; Published: October 13, 2022

Abstract

Functional interrupted aortic arch is a congenital malformation characterized by a complete separation between the ascending aorta and the descending aorta. Untreated patients are in danger of having late complications including cerebral hemorrhage, aneurysm formation, and aortic regurgitation. Traditionally, classical surgical therapies included bypass grafting or orthotopic repair. Herein, we report a simplified percutaneous therapy for functional interrupted aortic arch with a retrograde crossing technique and without an incremental-sized expandable balloon. With the guidance of 3-dimensional printing, percutaneous treatment with a covered stent is a feasible, safe, and effective alternative to surgery with excellent short- and midterm results in selected patients with favorable anatomy.

Introduction

Functional Interrupted Aortic Arch (IAA) is a congenital malformation characterized by a complete separation between the ascending aorta and the descending aorta. The presence of functional IAA in adults is extremely rare [1,2]. Patients with functional IAA can present with refractory hypertension and upper limb/lower limb systolic gradients. Untreated patients are in danger of having late complications including cerebral hemorrhage, aneurysm formation, and aortic regurgitation. Traditionally, classical surgical therapies included bypass grafting or orthotopic

repair. Transcatheter treatments for coarctation of the aorta have become more common in recent decades. Stenting therapy has also been used for functional IAA in limited cases with complicated and challenging techniques [3-5]. Due to high surgical risk, we simulated the procedure using a 3-dimensional (3D) printed model. During the procedures, all of these therapies used antegrade crossing techniques and dilation with a incremental-sized balloon. We report a simplified percutaneous therapy for functional IAA with a retrograde crossing technique and without an expanding incremental-sized balloon.

Case Presentation

A 17-year-old male presented with refractory hypertension and increasing dyspnea on exertion. The cardiac function was New York Heart Association functional class II. During the clinical examination, a bounding pulse was noted in the upper limbs, and the blood pressure in the upper limbs was 210/110 mm Hg. Femoral and all peripheral pulses in the lower limbs were absent, and the blood pressure was unrecordable. No pulse was found in the lower limbs. Echocardiography revealed mild to moderate aortic regurgitation. The left ventricular ejection fraction was depressed at 45% with dilatation of the left ventricle. Computed tomography angiography showed an interrupted aortic arch just distal to the origin of the left subclavian artery with a gap of 12 mm between the proximal and distal segments (Figure 1A, B).