An isolated left common carotid artery from the main pulmonary artery in a neonate with aortic valve atresia

Abstract

A 20-day-old girl was referred to our clinic for systolic murmur, cyanosis, and dyspnoea with feeding. Echocardiography revealed an atretic aortic valve. CT angiography scan revealed that the left common carotid artery originated from the distal main pulmonary artery. The plan was patent ductus artriosus stenting and bilateral pulmonary artery banding and then follow-up for any possible future intervention.

Isolated left common carotid artery: multidisciplinary management is the key to success

“…Isolation of the carotid artery is a rare form of aortic arch anomaly, with only 15 cases reported thus far (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] All except one case had a right aortic arch with an isolated left carotid artery. 14 In three patients, only the internal carotid artery was isolated, and the external carotid artery was arising from the aorta (8,11,14).…”

“…However, the presence of independent ipsilateral arterial duct or ductal ligament in 9 out of 15 reported cases (60%) as well as in the index case makes the connection between isolated carotid artery with the pulmonary artery unlikely to be via an arterial duct. 3,7,9,10,[12][13][14][15][16] Some authors have proposed an alternative hypothesis of malseptation of the trunco-aortic sac to explain the isolation of the aortic arch artery, especially the carotid artery. 6,9,16,19 Although not reported previously, the coexistence of anomalous origin of right coronary artery from the isolated left common carotid artery in our case also favours the theory of malseptation of the trunco-aortic sac (Fig 9).…”

“…The isolated carotid artery is the rarest form of arch vessel isolation, with only 15 cases reported thus far. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Surgical reimplantation of the isolated carotid artery is the preferred option. Nonetheless, the risk of post-operative cerebral hyperperfusion syndrome mandates careful preoperative evaluation and perioperative management.…”

The closing process of the ductus arteriosus connecting the left common carotid artery and main pulmonary artery

“…Significant associated congenital cardiac defects were also often present in cases with isolated left common carotid artery from the pulmonary artery: primum atrial septal defect, 5 secundum atrial septal defect, tetralogy of Fallot, 6 persistent left supra vena cava, 7 aortic atresia, 8 Ebstein anomaly, 4 CHARGE syndrome, 1 , 4 DiGeorge syndrome, 9 or hemifacial abnormality 7 . Our case had anovulvar fistula, without any other abnormality including coloboma, genital anomaly, and ear abnormality, and she had normal karyotype and fluorescence in situ hybridisation result for 22q11 deletion.…”