Incidental Finding of Interrupted Aortic Arch in an Adult Patient Who Underwent Urgent Percutaneous Coronary Intervention

Clinical Image

Austin J Clin Cardiolog. 2023; 9(1): 1101.

Incidental Finding of Interrupted Aortic Arch in an Adult Patient Who Underwent Urgent Percutaneous Coronary Intervention

Vadalà G¹*, Adorno D², Sucato V1,2, De Ornelas B², Ferraiuoli G², Lo Varco A¹ and Galassi AR²

¹Division of Cardiology, University Hospital Paolo Giaccone, Italy

²Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Italy

*Corresponding author: Giuseppe Vadalà Division of Cardiology,University Hospital Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy

Received: November 29, 2022; Accepted: December 27, 2022; Published: January 02, 2023

Abstract

Different vascular abnormalities have been reported concerning congenital anomalies of the aortic arch. We report a case of Interrupted Aortic Arch (IAA) discovered in the setting of acute coronary syndrome.

Keywords: Interrupted aortic arch (IAA); ACS; Complex percutaneous coronary interventions (PCI); Images in cardiology

Abbreviations: IAA: Interrupted Aortic Arch; PCI: Percutaneous Coronary Intervention; NSTEMI: Non-ST Segment Elevation Myocardial Infarction; DSA: Digital Subtraction Angiography; CT: Computed Tomography

Clinical Image

Interrupted Aortic Arch (IAA) is a very rare congenital abnormality that affects 3 per million live-births. If left untreated, it is associated with a mortality rate of more than 90% at 1 year [1]. Its occurrence in adults with atherosclerotic coronary heart disease is therefore rare, making Percutaneous Coronary Intervention (PCI) very challenging, especially in the setting of emergency care and when the abnormality in unknown. To our best knowledge, just one case report of IAA in the context of Acute Coronary Syndrome has been reported before [2].

A 58 years old woman complaining of Non-ST Segment Elevation Myocardial Infarction (NSTEMI) underwent urgent coronary angiography. Via the right radial artery it was not possible to reach ascending aorta because the presence of tangled arteries connecting the pre-vertebral subclavian segment to the descending aorta. A Digital Subtraction Angiography (DSA) of the aorta performed through left radial access showed the interruption of the aortic arch, distal to the origin of the left subclavian artery (A-B). Coronary angiography and right coronary artery PCI were performed through left radial access (C-D). Angio-CT confirmed the Aortic Arch interruption and showed the tangled collateral vessels connecting both subclavian arteries to the descending aorta (Figure 2A-B-C).

Figure 1: A-B: Digital Subtraction Angiography. A. Tangled vessel connection from Right Subclavian Artery to the Descending Aorta. B: Short occlusion of the Descending Aorta distal to the left subclavian artery origin. C: Coronary Angiography: Proximal right coronary artery critical stenosis (White Arrow). D: Result after stenting. E: Computed Tomography Angiography (CTA) MPR reconstruction. See the aortic occlusion after the left subclavian artery origin. F: Computed Tomography Angiography (CTA) MPR reconstruction showing left ventricular hypertrophy. G-H: Angio CT Volume-rendered images. G: Lateral view projection showing the interruption of the Aortic Arch, distally to the left Subclavian Artery. H: antero-posterior projection showing the tangled vessels connections, running very close to the back spine, from both Subclavian Arteries to the Descending Aorta.


    


    

    


    


    Figure 1: A-B: Digital Subtraction Angiography. A. Tangled vessel

connection from Right Subclavian Artery to the Descending Aorta.

B: Short occlusion of the Descending Aorta distal to the left subclavian

artery origin. C: Coronary Angiography: Proximal right coronary

artery critical stenosis (White Arrow). D: Result after stenting.

E: Computed Tomography Angiography (CTA) MPR reconstruction.

See the aortic occlusion after the left subclavian artery origin.

F: Computed Tomography Angiography (CTA) MPR reconstruction

showing left ventricular hypertrophy.

G-H: Angio CT Volume-rendered images. G: Lateral view projection

showing the interruption of the Aortic Arch, distally to the left Subclavian

Artery. H: antero-posterior projection showing the tangled

vessels connections, running very close to the back spine, from

both Subclavian Arteries to the Descending Aorta.

References

  1. Hanneman K, Newman B, Chan F. Congenital variants and anomalies of the aortic arch. Radiogr Rev Publ Radiol Soc N Am Inc. 2017; 37: 32–51.
  2. Luís Alberto, Oliveira Dallan, Adriano Milanez, Luiz Augusto F. Lisboa, Fabio B. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch. Jatene Revista Brasileira de Cirurgia Cardiovascular. 2013; 28: 290–1.

Citation: Vadalà G, Adorno D, Sucato V, De Ornelas B, Ferraiuoli G, et al. Incidental Finding of Interrupted Aortic Arch in an Adult Patient Who Underwent Urgent Percutaneous Coronary Intervention. Austin J Clin Cardiolog. 2023; 9(1): 1101.