Medical treatment of an adult with uncorrected isolated interrupted aorta resulted in no complications after 4 years of follow-up.

PATIENT: Female, 56. FINAL DIAGNOSIS: Isolated adult interrupted aortic arch. SYMPTOMS: Headache • hypertension • left ventricular hypertrophy. MEDICATION: -. CLINICAL PROCEDURE: -. SPECIALTY: Surgery. OBJECTIVE: Congenital defects/diseases. BACKGROUND: Interrupted aorta is a rare congenital malformation defined as the lack of continuity between the ascending and descending parts of the aorta. CASE REPORT: This malformation was first described by Steidele in 1778. To date a few isolated adult interrupted aortic arch patients have been reported and most of them were treated surgically. However, there is not data about outcome of patients who decline surgery or who are not good candidates for surgery because of excessive risks, and there is not a data about how to follow these patients. CONCLUSIONS: Herein we present a case of adult type A isolated interrupted aorta followed-up for 4 years by medical therapy without complications.

Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial.

BACKGROUND: Several protective therapies have been developed to prevent contrast-induced nephropathy (CIN). We aimed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens, including combination of N-acetylcysteine (NAC) plus sodium chloride and sodium chloride alone, to prevent CIN in patients undergoing cardiovascular procedures. METHODS: We prospectively enrolled 264 patients who were scheduled for cardiovascular procedures and had a baseline creatinine level >1.2 mg/dL. The patients were assigned 1 of 3 prophylactic regimens: infusion of sodium bicarbonate, sodium chloride, sodium chloride plus oral NAC (600 mg bid). Contrast-induced nephropathy was defined as an increase in serum creatinine level >25% or 0.5 mg/dL after 48 hours. RESULTS: There were no significant differences among groups regarding baseline demographic properties and nephropathy risk factors. The change in creatinine clearance was significantly better in the sodium bicarbonate group than other 2 groups (P = .007). The incidence of CIN was significantly lower in the sodium bicarbonate group (4.5%) compared with sodium chloride alone (13.6%, P = .036) and tended to be lower than in the combination group (12.5%, P = .059). After adjusting the Mehran nephropathy risk score, the risk of CIN significantly reduced with sodium bicarbonate compared with sodium chloride alone (adjusted risk ratio 0.29, P = .043). CONCLUSIONS: Hydration with sodium bicarbonate provides better protection against CIN than the sodium chloride infusion does alone. Combination therapy of NAC plus sodium chloride did not offer additional benefit over hydration with sodium chloride alone.