Interrupted aortic arch detected 4 days after surgical ventricular septal defect and patent ductus arteriosus closure: a case report

Abstract

Background: Interrupted aortic arch is a loss of luminal continuity between ascending and descending aorta. In a patient with an interrupted aortic arch, systemic perfusion is supplied by ductus arteriosus. Therefore, ductal closure will lead to systemic hypoperfusion. We present a case of undiagnosed type A interrupted aortic arch on initial examination. Case Presentation: A 4-month-old patient had signs of systemic hypoperfusion after a successful surgical ventricular septal defect and patent ductus arteriosus closure. Blood pressure between the upper and lower extremities showed a wide discrepancy. Echocardiography showed no flow from the aortic arch to the descending aorta. Emergency re-operation was performed, and type A interrupted aortic arch was found with descending aorta connected to the pulmonary artery. The interrupted aortic arch repair was performed using end to side technique. The patient was discharged on a post-operative day 26 without any complication, and no abnormalities were found on a 3-month follow-up. Conclusion: Careful physical examination, including BP measurement of all extremities, is warranted. To avoid misdiagnosis, preoperative echocardiography must be performed thoroughly to assess cardiac and great vessel abnormalities, including color flow Doppler.