11/12/2023 0 Comments Interrupted aortic arch neural crest![]() Of the 40 patients reported, more than half were treated surgically 5, 6. IAA in adult patients can live for many years asymptomatically due to existence of extensive collateral arteries (CAs), and whether these patients should be treated medically or with surgical repair has not been determined. Of the 40 reported adult patients with IAA, only 3 presented with congestive heart failure as IAA in the adult usually develops extensive collateral arteries 1, 2, 3, 4. As for IAA in adult patient, it is extremely uncommon with only 40 cases documented so far. The prognosis of patients with IAA is very poor as congestive heart failure develops in neonates who are left uncorrected, leading to 90% mortality within 4 days of birth 2. IAA is much more frequently encountered in the neonate, and immediate surgical intervention remains the only therapy. IAA is an uncommon congenital malformation of the aortic arch that occurs in 3 per million live births and accounts for only 1% of all congenital heart disease 1. Interrupted aortic arch (IAA) is defined as a complete loss of luminal and anatomic continuity between ascending and descending parts of the aorta 1. CFD analysis in IAA can provide a clinical reference, and the results should be further studied in depth in the future. It is concluded that the specific geometrical features of the extensive major CAs might result in the risky hemodynamics leading to the initiation and development of AD in this particular IAA patient. Moreover, it is found that only a jet flow which circumferentially washes out the aortic wall might cause tears on the wall. The simulation revealed that the jet flows from the collateral arteries (CAs) induced risk hemodynamic forces on the lumen wall including high time-averaged wall shear stress (TAWSS), high pressure and rapid change of WSS direction throughout the cardiac cycle. Hemodynamic parameters including the flow pattern, pressure distribution, and wall shear stress (WSS) indicators were obtained. ![]() In this paper, we carried out the numerical investigation on the hemodynamics in a patient-specific IAA model, which was reconstructed from computed tomography images. It is quite perplexing because there seems to be no risk factors for the development of AD at DAo such as long-term uncontrolled hypertension, atherosclerosis, aortic aneurysm or genetic disorder. However, reports of sporadic aortic dissection (AD) of descending aorta (DAo) in IAA in adults before surgery drew our attention. There is no clear evidence for the preferred selection of surgical repair versus conservatively medical treatment for the uncertain effects of both treatments. The guideline for the treatment of interrupted aortic arch (IAA) in adults has not been established although most centers tend to propose surgery.
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