To the Editor:
We read with interest the case of an isolated interrupted aortic arch in a 72-year-old man, by Alam and co-authors.1 Looking at the figures, however, we had some doubts about whether this anomaly was a real interrupted aortic arch or whether it was aortic coarctation.
In 2004, a similar question was raised in a comprehensive editorial by Vriend and colleagues2 concerning a case reported by Akdemir's group.3 We agree with Vriend's point of view, which can be applied to the present case. Isolated interruption of the aortic arch is extremely rare compared with aortic coarctation, and survival beyond the 1st year is highly unusual without surgical correction. Type A aortic interruption and aortic coarctation have similar anatomic locations, just distal to the left subclavian artery. The hallmark feature of aortic interruption that is useful to differentiate it from aortic coarctation is the “complete absence” of continuity between both parts of the interrupted segment.
In our opinion, interruption of the aortic arch is not depicted in the figures in Alam's report. Figure 5, for example, shows that the arch retains its curvature, and the ascending aorta and aortic arch have a normal or slightly enlarged caliber. In cases of interrupted aortic arch, the arch is typically of smaller caliber than normal, and the branches have a straighter course.2 Considering these features and the clinical picture of the patient, we think it is likely that this case was one of aortic coarctation, rather than interrupted aortic arch. Therefore, we call attention to the article by Vriend's group,2 which presents a detailed analysis of the types and origin of interrupted aortic arch, as well as the major differences between interrupted arch and aortic coarctation.
Cem Barcin, MD, MSc
Hurkan Kursaklioglu, MD
Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey
Footnotes
Letters to the Editor should be no longer than 2 double-spaced typewritten pages and should contain no more than 6 references. They should be signed, with the expectation that the letters will be published if appropriate. The right to edit all correspondence in accordance with Journal style is reserved by the editors.
References
- 1.Alam M, Simpson L, Virani SS, Cheong B, Loyalka P, Civitello AB. Incidental diagnosis of interrupted aortic arch in a 72-year-old man. Tex Heart Inst J 2009;36(5):494–5. [PMC free article] [PubMed]
- 2.Vriend JWJ, Lam J, Mulder BJM. Complete aortic arch obstruction: interruption or aortic coarctation? Int J Cardiovasc Imaging 2004;20(5):393–6. [DOI] [PubMed]
- 3.Akdemir R, Ozhan H, Erbilen E, Yazici M, Gunduz H, Uyan C. Isolated interrupted aortic arch: a case report and review of the literature. Int J Cardiovasc Imaging 2004;20(5):389–92. [DOI] [PubMed]