Interrupted aortic arch with retrograde subclavian perfusion

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Vascular Physiology

Background:

• Type B interrupted aortic arch typically involves left subclavian artery perfusion via a patent ductus arteriosus with antegrade flow.
• Understanding atypical hemodynamics is crucial for managing complex congenital heart defects.

Observation:

• A case of Type B interrupted aortic arch with a restrictive patent ductus arteriosus presented with unusual retrograde perfusion of the left subclavian artery.
• This retrograde flow occurred through the circle of Willis, mimicking subclavian steal syndrome.

Findings:

• The retrograde subclavian artery perfusion was driven by higher perfusion pressure within the cerebral circulation compared to the left subclavian artery.
• This phenomenon indicates significant restriction at the patent ductus arteriosus level.

Implications:

• Early identification of retrograde subclavian artery flow can guide management by revealing ductal restriction.
• Comprehensive assessment of ventricular systolic function and ductal hemodynamics is essential when retrograde subclavian artery flow is observed.