Assessment of interrupted aortic arch with magnetic resonance angiography

RevPortCardiol.2014;33(11):741---742

Revista

Portuguesa

de

Cardiologia

Portuguese

Journal

of

Cardiology

www.revportcardiol.org

IMAGE

IN

CARDIOLOGY

Assessment

of

interrupted

aortic

arch

with

magnetic

resonance

angiography

A

avaliac

¸ão

do

arco

aórtico

interrompido

por

angiografia

com

ressonância

magnética

Fahri

Halit

Besir

_,

_Yasemin

_Turker

_,

_Yasin

_Turker

_,

_Omer

_Onbas

a_{DuzceUniversitySchoolofMedicine,DepartmentofRadiology,Duzce,Turkey} b_{DuzceFamilyMedicineCenter,Duzce,Turkey}

c_{DuzceUniversity,MedicineSchool,DepartmentofCardiology,Duzce,Turkey}

Received7March2014;accepted1April2014 Availableonline11November2014

A22-year-old manwasreferred toourcardiology depart-mentforinvestigationofhypertension.Atpresentationhis bloodpressurewas170/100mmHginbotharms,andheart rate was74 beats/min. The pulses were equal over both upperextremities,butbilateralfemoralandpoplitealpulses were extremely weak andthe dorsalis pedisand anterior tibialpulseswerenotpalpable.Hispasthistorywas unre-markableexceptforhypertension.TherewasaII/VIsystolic ejectionmurmurintheleftsecondintercostalareaandleft scapularregionintheback.Transthoracicechocardiography showedconcentricleftventricularhypertrophywithnormal ventricular function. Magnetic resonance (MR) angiogra-physhowedinterruptionofthedescendingaortaafterthe branchingof the leftsubclavianartery(Figure1).Dilated intercostal,intramammaryandthoracodorsalarterieswith

∗_{Correspondingauthor.}

E-mailaddress:drfhbesir@gmail.com(F.H.Besir).

accompanyinganastomosisbetweentheintercostaland tho-racodorsalarterieswereobserved(Figure2).

Interrupted aortic arch is defined asa complete lumi-nalandanatomicdiscontinuitybetweentheascendingand descendingaorta.It isa rareandsevere congenitalheart defect witha very poor prognosis without surgical treat-ment. Conventional angiography is considered the gold standardandis frequentlyusedinvascularimaging. How-ever, MR imaging with excellent anatomic and functional capabilities can be performed easily, and with advances in imaging technology, acquiring information comparable tothatof conventional angiographyhas become feasible. MRcan alsobe usedtoassess thevascular anatomy from several views with maximum intensity projection recon-structions.

http://dx.doi.org/10.1016/j.repc.2014.04.006

742 F.H.Besiretal.

Figure1 Three-dimensional volume rendering magnetic resonance angiography images: (A) left posterior oblique view and (B)rightposteriorobliqueview,showinginterruptionofthedescendingaortaafter thebranchingoftheleft subclavianartery. IA:interruptedaorta;IMA:internalmammaryartery;LCCA:leftcommoncarotidartery;LSCA:leftsubclavianartery;RCCA:right commoncarotidartery;TrBc:truncusbrachiocephalicus.

Figure2 Three-dimensionalvolumerenderingmagnetic res-onance angiography images, anterior coronal view, showing dilatedintercostal,intramammary andthoracodorsalarteries withaccompanyinganastomosisbetweenthoracodorsalartery branchesandintercostalarteries.An:anastomosis.

Ethical

disclosures

Protection of human and animal subjects.The authors declarethatnoexperimentswereperformedonhumansor animalsforthisstudy.

Confidentialityofdata.Theauthorsdeclarethatnopatient dataappearinthisarticle.

Right to privacy and informed consent.The authors declarethatnopatientdataappearinthisarticle.

Conflicts

of

interest