IAA is a very rare congenital heart defect (affecting 3 per million live births) 1) in which the aorta is not completely developed. PCI for mid-left anterior descending artery was successfully performed though a left radial artery. The right brachial artery was totally occluded, but there was good flow through a vigorous collateral vessel (A). We closely followed the patient, provided optimal medical therapy for IAA, and performed PCI for coronary artery stenosis using a heart team approach. He denied surgery for financial reasons and did not experience further health problems. He was told that he needed surgery to correct a serious congenital heart disease. Aortogram confirmed IAA and collateral flow from intrathoracic arteries to the descending aorta ( Supplementary Video 1). Percutaneous coronary intervention (PCI) was successfully performed though a left radial artery ( Figure 3B and C). The angiogram showed occlusion of the brachial artery with good down-stream blood flow through a collateral vessel ( Figure 3A). During coronary angiography, access was achieved through a right radial artery, but the guidewire could not pass though the right brachial artery. A ventricular septal defect was found on echocardiogram, left ventricular ejection fraction was 68%, and right ventricular size and function were within normal range without pulmonary hypertension ( Figure 2). Aorta CTA revealed interruption of aortic arch (IAA) with multiple collateral channels ( Figure 1B-D). Coronary computed tomography angiogram (CTA) showed 70%–90% stenosis in the mid-left anterior descending artery and discontinuity of the aortic arch between the left subclavian artery and descending aorta without patent ductus arteriosus ( Figure 1A). His blood pressure was 171/98 mmHg in the left arm and 109/51 mmHg in the left leg. A 51-year-old male presented at our hospital with exertional chest pain.
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