Incidental diagnosis of interrupted aortic arch in a 72-year-old man.

A 72-year-old man who had chest pain and an abnormal myocardial perfusion scan was brought to the cardiac catheterization laboratory for evaluation. The patient had a history of refractory hypertension and had experienced symptoms of intermittent claudication for several years. A guidewire could not be passed to the aortic arch via the femoral approach; descending thoracic aortography revealed complete occlusion of the descending thoracic aorta (Fig. 1). A right ventriculogram, performed with an NIH catheter, confirmed complete occlusion of the aorta distal to the origin of the left subclavian artery (Fig. 2). Multiple collateral vessels filled the descending aorta. The bilateral renal arteries were patent. There was an 80-mmHg gradient between the femoral artery and the aortic arch, which was accessed using a right brachial artery approach. The patient underwent magnetic resonance angiography (MRA). Figures 3 and 4 show selected MRA cuts that reveal the interruption in the aortic arch and the prominent collateral vessels to the descending aorta. The patient was also found to have a bicuspid aortic valve; a 3-dimensional MRA reconstruction is shown in Figure 5. Images in Cardiovascular Medicine