Introduction: Aortic arch interruption is a rare congenital heart malformation, often associated with Di-George syndrome in type B of Celoria-Patton or other cardiac abnormalities. It is a major life-saving neonatal medical and surgical emergency. Surgical treatment in developing countries is limited by insufficient technical resources, especially in sub-Saharan Africa.

Observation: We report the case of a 28-day-old newborn successfully operated for a type B aortic arch interruption associated with a VSD and PDA in the Thoracic and Cardiovascular Surgery Department of the Fann National University Hospital in Dakar, Senegal. The repair consisted of closure of the VSD and the ductus arteriosus, and restoration of aortic continuity by end-to-end aorto-aortic anastomosis. She presented with postoperative hydro-electrolytic disturbances which were corrected. A superficial infection of the surgical site, which occurred from day 15 with suture release without fever, evolved favorably under antibiotics and local care. A secondary suture was made on day 45. The patient was discharged from intensive care on day 30 and returned home on day 60. The clinical examination and cardiac ultrasound at 1 year were satisfactory. The prognosis was considered good.

Conclusion: Type B aortic arch interruption is rare, and its ductal dependence makes it a medical and surgical emergency. Appropriate and urgent medical and surgical management can preserve the patient’s life.

• Type B Aortic Arch Interruption; Surgery; Dakar; Senegal

Bignandi K, Diop MS, Diallo AK, Diagne P, Ba PO, et al. (2025) Surgical Management of a Case of Aortic Arch Interruption in Senegal. Ann Cardiovasc Dis 9(1): 1039.

PA: Pulmonary Artery; CEC: Circulation Extra-Corporeal; CIV: Communication Inter Ventricular; LVEF: Function of Ejection of the Left Ventricle; EN: English; IAA: Interruption of the Arch Aortic; J: Day; Kg: Kilogram; l: Liter; mg: Mg; Min: Minute; Mm: Millimeter; ng: Nanogram; PCA: patent ductus Arteriosus; CT: computed Tomography; TABC: truncus Arteriosus Brachio-Cephalic; IVC: Inferior Vena Cava; VCS: Superior Vena Cava.

The interruption of the arch of the aorta is a congenital heart defect is rare and represents less than 1% of all congenital heart disease [1,2]. It touches 3 kids par million births, often associated with a syndrome of Di-George in the type B Celoria and Patton, or other cardiac abnormalities [3]. The ducto-dependence of this condition makes it an emergency neonatal vital major, often lethal [2,3]. Unlike in the developed countries, the treatment is essentially surgical is still limited by a plateau technique to be inadequate in the developing countries especially in sub-saharan Africa [4]. The prognosis is generally dark in the absence of surgical treatment because it is found that 10 % of survivors at 1 year of life [1-4]. We report the case of a new-born 28-days successfully operated on for an interruption of the arch aortic type B associated with a CIV and a PCWAS in the service of Thoracic and Cardiovascular Surgery-Vascular Centre Hospitalier National Universitaire de Fann, Dakar, Senegal.

It was a new-born 28 days, with no history of antenatal and perinatal individuals that was sent to us from the children’s hospital Albert Royer for the management of congenital heart disease, non-cyanotic complex (involving an interruption of the arch of the aorta, a CIV and a pda), discovered in the course of a cardiac assessment for a dyspnée during feedings from birth associated with pulse low in the lower limbs.

At the time of admission, she presented with respiratory distress (associating a polypnée surface with a respiratory rate to 47 cpm, a saturation préductale (to the right upper extremity) to 95% and postductale (in the left lower extremity) to 79%, a beat of the wings of the nose, a draw intercostal and supra-sternal). There was a tachycardia auscultatory 170 bpm, a breath meso-heart-intensity 2/6e. His poids was 2.743 Kg to a height of 45cm.

The treatment instituted was the furosemide 6mg/ day; the prostine 0,01 gamma/Kg/min; dobutamine 7,5 gamma/Kg/min, Amikacin 40mg/day and Ciprofloxacin 27 mgX3/j.

The electrocardiogram showed tachycardia sinusale regular to 176 bpm, left ventricular hypertrophy.

Ultrasound transthoracic found a heart in situs solitus and levocardia, left ventricular hypertrophy, a good systolic function bi-ventricular with a LVEF of 65%, a wide-CIV admission of 8 mm and a PCA of 2.4 mm, an ascending aorta to the left with a disruption of the ark after the birth of the artery, left carotid flow and cushioning to the level of the abdominal aorta.

The angiotomodensitométrie chest (Figure 1),

Figure 1: Angio-CT chest: an interruption of the arch aortic type B: orange Arrow: truncus arteriosus brachio-cephalic, blue Arrow: left common carotid, green Arrow : Left subclavian artery.

has revealed that an interruption of the arch aortic type B, with an ascending aorta of 6.4 mm, giving birth to the TABC and the carotid primitive left, aorta, descending measured 5.9 mm and is perfused by the artery pulmonary via a ductus arteriosus of 2.6 mm, and giving birth to the left subclavian. There was a dilatation tapering of the pulmonary artery (17 mm) with branches of birth modal, normal track, plus size (7 mm to the right and 8.2 mm gauche), a CIV of 7.6 mm. There was no abnormality of the venous return from the lungs.

Explorations biological showed the complete blood count hemoglobin 10.4 g/dl; Hematocrit: 30,4%; leukocytes : 15 750 items :mm3 ; plateall : 191 000 elements/mm3. The kidney function showed a urea: 0.35 g/l and the serum creatinine: 4,72 mg/l.

The treatment consisted of a corrective surgery by median sternotomy under cardiopulmonary bypass (CPB) with a cerebral perfusion exclusive. The CEC was carried out between the two cannulas, arterial 8 EN for the TABC through a tube GoreTex 6mm for selective cerebral perfusion and 10-EN to the stem of the AP allows an infusion of the lower part of the body ; and two cannula venous 12-EN each, right to the VCS and cubit for the VCI. The temperature was de 28. The gestures were a resection of the whole fabric of ductal closure by direct suturing of the insertion of the channel into the pulmonary artery, anastomosis termino-terminal aorta-aortic, and a closure of the VSD with a patch of pericardium heterologous through a atriotomie right. Figure 2 shows the appearance of postoperative after resection of the tissue, ductal.

Figure 2: View of the postoperative : blue Arrow : distal part of the aortic arch (left common carotid and subclavian artery), green Arrow : proximal part of the aortic arch (truncus arteriosus brachio-cephalic and common carotid (right).

The total duration of CPB was 247 minutes, the assistance of 67 minutes and the time course of clampage aortic was 142 minutes 35 minutes of cerebral perfusion exclusive. The patient is released open-chest (Figure 3).

Figure 3: View post-surgery: open chest.

The child has made a month in the icu. The thorax was closed at D5 post-operative after a balance-sheet input - negative output from J3. He has presented disorders hydro-electrolytic type, hyponatremia, acidosis, respiratory, corrected from J8. A superficial infection of the surgical site occurred from J15 post operatively with a breakdown of sutures and a purulent discharge but no fever. There was a leukocytosis (17 000 elements/ mm3) in multinuclear neutrophil, a Protéine C-reactive 156 mg/l and procalcitonin to 35 ng/l. examination cyto-bacteriological examination of the pus was not isolated germ. The patient was already on antibiotics since the pre-operatively. The support consisted of local care daily avec a favorable evolution. Figure 4 presents the state of the surgical wound to J30. A suture secondary has been made to J45. The return home was to J60.

Figure 4: Appearance of the surgical wound to J30 post-op.

Six months postoperatively, the clinical condition of the infants was satisfactory. The cardiac ultrasound control at one year included a heart in situs solitus and levocardia, left ventricular hypertrophy, a good systolic function bi-ventricular with a LVEF of 55%, a patch of the CIV waterproof, an absence of the ductus arteriosus, a beautiful arch aortic without stenosis. The prognosis was judged to be good after a recall of 1 year.

The interruption of the arch of the aorta is a rare congenital anomaly, as evidenced by the few cases and small series described in the literature since its first description by Abbott in 1927 [1-4]. The type B classification of Celoria and Patton is the most frequently encountered [3]. This first case in our service for more than a decade of surgical management of congenital heart disease, illustrates the rarity of the anomaly. It is most often within a framework ofe syndromes polymalformatifs of which the most common is the Di George syndrome [3]. The IAA may be associated with other cardiac defects (VSD, a birth aberrant left subclavian artery) [4-6]. This was the case for our child, where on was a CIV, a patent ductus arteriosus permeable. Survival without ductus arteriosus permeable has been described and will be possible thanks to the presence of collaterals providing a perfusion downstream [7]. However, the presence of a patent ductus arteriosus and the maintenance of the permeability by the use of the prostine, as in our case, allow a better perfusion of the distal and a good flow systemic at the time of diagnosis.

In developed countries, the diagnosis is usually made in the antenatal check-up. However, dan’s the country lanes of development, especially in sub-saharan Africa, as in our case, the diagnosis is made post-natal, sometimes in a state of cardiogenic shock [4,9]. The symptomatology is characterized by a shortness of breath during feedings, the pulse weak, especially in the lower limbs and the differential of saturation between the upper and lower limbs [9,10]. It is essentially based on an ultrasound of the heart. It also allows you to take stock of the other associated anomalies. The angio-CT remains the reference examination in the exploration of this congenital heart disease, comes complete ultrasound of the heart or bring more accuracy in case of doubt [10-12].

The surgical reconstruction of a beautiful arch, aortic-the plusoon as possible remains the gold standard therapy after a good resuscitation. The treatment of other cardiac abnormalities associated can be done in the same surgical time or delayed [13-15]. We have chosen in our case for a cure complete solution in a time of interruption of the arch of the aorta, of the CIV and the ductus arteriosus permeable CEC with a cerebral circulation - exclusive when performing the anastomosis of the aorta, as advocated by some authors [13]. We left le open chest because of the balance-sheet input – to-output high positive end of the procedure, associated with diffuse infiltration widespread. The chest has been closed 3 days later after negative balance input-output and the decrease of the infiltration.

In the event of the impossibility of realization of the anastomosis aorto-aortic termino-terminal on adult subjects, other authors recommend the use of a bypass aorto-aortic extra-cardiac [16].

The evolution is generally favorable when the treatment was early and adapted [14,16]. Our new-born has presented the persistence of disorders hydro-electrolytic and metabolic relieved by a resuscitation and medical treatment with a good evolution. She has also presented an infection of the surgical site superficial with well-advanced with antibiotic treatment probabilistic (not germ found) and local care.

The mortality revolves around around 5%, with a risk of anastomotic stricture amounting to 10% according to the authors [13-16]. Après a decline of 1 year, the prognosis of the patient is good without any sign of a complication.

The IAA is a rare congenital anomaly, often diagnosed during the neonatal period and the type B is the most common. Because of its ducto-dlength, it constitutes a surgical emergency. The surgical management of early and adapted to be framed by a good resuscitation can improve the prognosis. Our case is a first experience to be satisfactory and encouraging. Investigative genetics would have been necessary for the search for the Di George syndrome.

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