Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1984 Sep;11(3):250–259.

Interrupted Aortic Arch: Brief Review and Summary of an Eighteen-Year Experience

Michael J Reardon 1, Grady L Hallman 1, Denton A Cooley 1
PMCID: PMC341721  PMID: 15227058

Abstract

Interrupted aortic arch (IAA) is an uncommon congenital anomaly representing approximately 1% of congenital heart disease. More than 97% of the cases also have associated cardiac anomalies complicating their treatment. Because the median age at death in untreated cases is 10 days, this condition usually occurs as a complicated neonatal surgical emergency.

There are three types of IAA: Type A is interrupted distal to the left subclavian artery. Type B, which is the most common form, is interrupted between the left common carotid and the left subclavian arteries. Type C, which is the most uncommon type, is interrupted between the innominate and left common carotid arteries.

Since the first patient with this congenital anomaly was treated at our institution in 1965, 39 patients have undergone surgical treatment. Two of these (4.6%) had no associated intracardiac lesions, and both survived bypass grafting without complications. There were 12 Type A (30%), 26 Type B (67%) and one Type C (3%). A variety of individualized techniques were used to repair the defects. The three basic techniques were (1) direct aortic to aortic anastomosis bridging the gap, (2) “turndown” or “turnup” of one of the arch vessels to the aorta across the gap, or (3) bypass of the interruption with graft material.

Because aortic arch and associated cardiac anomalies represent a neonatal surgical emergency, our therapeutic plan consists of treatment for biventricular failure and PGE1infusion to maintain ductal patency, and surgical correction as soon as feasible.

Full text

PDF
250

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bailey L. L., Jacobson J. G., Doroshow R. W., Merritt W. H., Petry E. L. Anatomic correction of interrupted aortic arch complex in neonates. Surgery. 1981 May;89(5):553–557. [PubMed] [Google Scholar]
  2. Blalock A., Park E. A. The Surgical Treatment of Experimental Coarctation (Atresia) of the Aorta. Ann Surg. 1944 Mar;119(3):445–456. doi: 10.1097/00000658-194403000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. CELORIA G. C., PATTON R. B. Congenital absence of the aortic arch. Am Heart J. 1959 Sep;58:407–413. doi: 10.1016/0002-8703(59)90157-7. [DOI] [PubMed] [Google Scholar]
  4. CONCEPCION RUIZ VILLALOBOS M., DE BALDERRAMA D. P., LOPEZ Y LOPEZ J., CASTELLANOS M. Complete interruption of the aorta. Am J Cardiol. 1961 Nov;8:664–669. doi: 10.1016/0002-9149(61)90369-1. [DOI] [PubMed] [Google Scholar]
  5. Cooley D. A., Duncan J. M. Temporary aortic control during resection of distal arch lesions: the innominate factor. Tex Heart Inst J. 1982 Mar;9(1):33–36. [PMC free article] [PubMed] [Google Scholar]
  6. Cooley D. A., Livesay J. J. Technique of "open" distal anastomosis for ascending and transverse arch resection. Cardiovasc Dis. 1981 Sep;8(3):421–426. [PMC free article] [PubMed] [Google Scholar]
  7. Copeland J. G., Record J. A., Salomon N. W., Sahn D. J., Allen H. D., Goldberg S. J. Successful palliation using partial cardiopulmonary bypass in a two-day-old infant with type B interruption of the aortic arch. J Thorac Cardiovasc Surg. 1978 Oct;76(4):495–499. [PubMed] [Google Scholar]
  8. Dische M. R., Tsai M., Baltaxe H. A. Solitary interruption of the arch of the aorta. Clinicopathologic review of eight cases. Am J Cardiol. 1975 Feb;35(2):271–277. doi: 10.1016/0002-9149(75)90012-0. [DOI] [PubMed] [Google Scholar]
  9. EVERTS-SUAREZ E. A., CARSON C. P. The triad of congenital absence of aortic arch (isthmus aortae), patent ductus arteriosus and interventricular septal defect; a trilogy. Ann Surg. 1959 Jul;150(1):153–159. doi: 10.1097/00000658-195907000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gokcebay T. M., Batillas J., Pinck R. L. Complete interruption of the aorta at the arch. Am J Roentgenol Radium Ther Nucl Med. 1972 Feb;114(2):362–370. doi: 10.2214/ajr.114.2.362. [DOI] [PubMed] [Google Scholar]
  11. Heymann M. A., Berman W., Jr, Rudolph A. M., Whitman V. Dilatation of the ductus arteriosus by prostaglandin E1 in aortic arch abnormalities. Circulation. 1979 Jan;59(1):169–173. doi: 10.1161/01.cir.59.1.169. [DOI] [PubMed] [Google Scholar]
  12. Ho S. Y., Wilcox B. R., Anderson R. H., Lincoln J. C. Interrupted aortic arch--anatomical features of surgical significance. Thorac Cardiovasc Surg. 1983 Aug;31(4):199–205. doi: 10.1055/s-2007-1021980. [DOI] [PubMed] [Google Scholar]
  13. Ito K., Kohguchi N., Ohkawa Y., Akasaka T., Ohara H., Takarada M., Aoki H., Ogata M., Nishibatake M., Fukatsu O. Total one-stage repair of interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus. J Thorac Cardiovasc Surg. 1977 Dec;74(6):913–917. [PubMed] [Google Scholar]
  14. Jacobson J. G., Trusler G. A., Izukawa T. Repair of interrupted aortic arch and aortopulmonary window in an infant. Ann Thorac Surg. 1979 Sep;28(3):290–294. doi: 10.1016/s0003-4975(10)63122-0. [DOI] [PubMed] [Google Scholar]
  15. Kron I. L., Rheuban K. S., Carpenter M. S., Nolan S. P. Interrupted aortic arch. A conservative approach for the sick neonate. J Thorac Cardiovasc Surg. 1983 Jul;86(1):37–40. [PubMed] [Google Scholar]
  16. Lang P., Freed M. D., Rosenthal A., Castaneda A. R., Nadas A. S. The use of prostaglandin E1 in an infant with interruption of the aortic arch. J Pediatr. 1977 Nov;91(5):805–807. doi: 10.1016/s0022-3476(77)81047-0. [DOI] [PubMed] [Google Scholar]
  17. Matsumoto H., Nakamura T., Sezaki T., Kobayashi H., Endoh T., Saitoh M., Nanba Y., Nakada I. Interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus: successfully repaired by means of a new surgical procedure. J Cardiovasc Surg (Torino) 1982 Sep-Oct;23(5):422–425. [PubMed] [Google Scholar]
  18. Monro J. L., Brawn W., Conway N. Correction of type B interrupted aortic arch with ventricllar septal defect in infancy. J Thorac Cardiovasc Surg. 1977 Oct;74(4):618–623. [PubMed] [Google Scholar]
  19. Moore G. W., Hutchins G. M. Association of interrupted aortic arch with malformations producing reduced blood flow to the fourth aortic arches. Am J Cardiol. 1978 Sep;42(3):467–472. doi: 10.1016/0002-9149(78)90942-6. [DOI] [PubMed] [Google Scholar]
  20. Muraoka R., Yokota M., Aoshima M., Nomoto S., Osaragi M., Kyoku I., Nakano H., Ueda K., Saito A. Simplified method for total correction of interrupted aortic arch with ventricular septal defect in infancy. J Thorac Cardiovasc Surg. 1979 Nov;78(5):744–749. [PubMed] [Google Scholar]
  21. Murphy D. A., Lemire G. G., Tessler I., Dunn G. L. Correction of type B aortic arch interruption with ventricular and atrial septal defects in a three-day-old infant. J Thorac Cardiovasc Surg. 1973 Jun;65(6):882–886. [PubMed] [Google Scholar]
  22. Neye-Bock S., Fellows K. E. Aortic arch interruption in infancy: radio- and angiographic features. AJR Am J Roentgenol. 1980 Nov;135(5):1005–1010. doi: 10.2214/ajr.135.5.1005. [DOI] [PubMed] [Google Scholar]
  23. Norwood W. I., Lang P., Castaneda A. R., Hougen T. J. Reparative operations for interrupted aortic arch with ventricular septal defect. J Thorac Cardiovasc Surg. 1983 Dec;86(6):832–837. [PubMed] [Google Scholar]
  24. PILLSBURY R. C., LOWER R. R., SHUMWAY N. E. ATRESIA OF THE AORTIC ARCH. Circulation. 1964 Nov;30:749–754. doi: 10.1161/01.cir.30.5.749. [DOI] [PubMed] [Google Scholar]
  25. Schaff H. V., Donahoo J. S. Repair of type B interruption of the aortic arch in a three day old infant using microporous expanded polytetrafluoroethylene arterial prosthesis. J Cardiovasc Surg (Torino) 1979 Jan-Feb;20(1):57–60. [PubMed] [Google Scholar]
  26. Speir A. M., Grey D. P., Cooley D. A. Resection of the aortic arch with moderate hypothermia and temporary circulatory arrest. Tex Heart Inst J. 1982 Sep;9(3):311–320. [PMC free article] [PubMed] [Google Scholar]
  27. Sturm J. T., vanHeeckeren D. W., Borkat G. Surgical treatment of interrupted aortic arch in infancy with expanded polytetrafluoroethylene grafts: two-year follow-up results. J Thorac Cardiovasc Surg. 1981 Feb;81(2):245–249. [PubMed] [Google Scholar]
  28. Utley J. R., Swain J. A., Higgins C. B., Kashani I. A. Pulmonary artery partition: new method for correction of interrupted aortic arch. J Thorac Cardiovasc Surg. 1983 Aug;86(2):309–311. [PubMed] [Google Scholar]
  29. Van Praagh R., Bernhard W. F., Rosenthal A., Parisi L. F., Fyler D. C. Interrupted aortic arch: surgical treatment. Am J Cardiol. 1971 Feb;27(2):200–211. doi: 10.1016/0002-9149(71)90259-1. [DOI] [PubMed] [Google Scholar]
  30. Ventemiglia R., Oglietti J., Wukasch D. C., Hallman G. L., Cooley D. A. Interruption of the aortic arch. Surgical considerations. J Thorac Cardiovasc Surg. 1976 Aug;72(2):235–242. [PubMed] [Google Scholar]
  31. van der Horst R., Hastreiter A. R., Levitsky S., Fisher E. A., DuBrow I. W., Weinberg M. Interrupted aortic arch operation in the first week of life: hemodynamic and angiographic evaluation one year later. Ann Thorac Surg. 1979 Feb;27(2):112–120. doi: 10.1016/s0003-4975(10)63250-x. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES