Diagnosis of Interrupted Aortic Arch in an Adult during Coronary Artery Evaluation

摘要

A 51-year-old male presented at our hospital with exertional chest pain. His blood pressure was 171/98 mmHg in the left arm and 109/51 mmHg in the left leg. Coronary computed tomography angiogram (CTA) showed 70%–90% stenosis in the mid-left anterior descending artery and discontinuity of the aortic arch between the left subclavian artery and descending aorta without patent ductus arteriosus (Figure 1A). Aorta CTA revealed interruption of aortic arch (IAA) with multiple collateral channels (Figure 1B-D). A ventricular septal defect was found on echocardiogram, left ventricular ejection fraction was 68%, and right ventricular size and function were within normal range without pulmonary hypertension (Figure 2). During coronary angiography, access was achieved through a right radial artery, but the guidewire could not pass though the right brachial artery. The angiogram showed occlusion of the brachial artery with good down-stream blood flow through a collateral vessel (Figure 3A). Percutaneous coronary intervention (PCI) was successfully performed though a left radial artery (Figure 3B and C). Aortogram confirmed IAA and collateral flow from intrathoracic arteries to the descending aorta (Supplementary Video 1). He was told that he needed surgery to correct a serious congenital heart disease. He denied surgery for financial reasons and did not experience further health problems. We closely followed the patient, provided optimal medical therapy for IAA, and performed PCI for coronary artery stenosis using a heart team approach.