Case of the week 08:10

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Case of the week 0810 Interrupted Aortic Arch
Clinical History 2 day old ?, mild respiratory
distress. Clinical examination Holosystolic
murmur at the mid-sternal border. CXR Esophageal
atresia with tracheoesophageal fistula. Echocardio
gram Large primum and secundum ASD, single AV
valve, large inlet VSD, dilated pulmonary
annulus, large PDA. Small left ventricle with
small aortic annulus and incompletely visualized
aortic arch. Main pulmonary artery severely
dilated. Color Doppler Bidirectional shunting
at the atrial level,
a
b
predominantly left to right. Flow across PDA also
appeared bidirectional. CMR with contrast 3D MRA
Aortogram Real time cine images demonstrated
complete interruption of aortic arch after LCCA
(Type B). The dotted line in images a, and b
shows where the course of the aorta should be.
From the 3D angiogram LSCA arises post-ductal.
Large PDA supplies entire descending aorta
creating a pseudo-arch appearance.
Perspective CMR in conjunction with 3D MRA
allows for diagnosis of interrupted aortic arch
even in very young (lt 48 hours life) pediatric
patient without the risk of radiation.
Cory Nitzel, Nishant Kalra, Dena Wilson, J Carlos
Macias, Vincent Sorrell. Sarver Heart Center,
University of Arizona, Tucson, Arizona,USA.
Handling Editor Mark Westwood