Isolated left brachiocephalic trunk arising from the main pulmonary artery with right aortic arch

Abstract

Anomalous origin of the left brachiocephalic trunk from the main pulmonary artery with right aortic arch is an extremely rare congenital anomaly. These types of cases are incidentally diagnosed in adults and children with symptoms of vertebral basilar insufficiency. We report the clinical findings, investigation, and management of a case of this rare congenital anomaly.

Incomplete isolation of the left innominate artery from the right aortic arch: a rare case of double-outlet right ventricle with pulmonary stenosis

“…2 We postulated that our patient had a right aortic arch with mirror-image branching with the exceptions of the incompletely regressed left branch of aortic sac and left patent ductus arteriosus. There are several case reports of isolated left innominate artery due to the interruption of the left branch of the aortic sac 3,4,5,6,7 ; however, to the best of our knowledge, there is only one case report on incomplete isolation of the left innominate artery. 8 In our patient, pulmonary stenosis worsened over time in the setting of aggravating right ventricular outflow obstruction; the pulmonary blood flow was solely delivered via the left carotid artery and the narrow connection between the ascending aorta and the left innominate artery when she underwent surgery.…”

“…The difference in blood pressure between the arms is a significant clinical sign of this anomaly. 4 The blood flow is reduced in the left arm because it is supplied either by backward flow in the left carotid artery starting from the right carotid artery and the right vertebral artery using the circle of Willis or by collateral arteries. Although there was a narrow connection between the left innominate artery and the ascending aorta, the left arm of our patient was already smaller compared with the right arm at 3 months of age.…”

Isolated left brachiocephalic artery with the right aortic arch

“…[1013] Asymptomatic patients without associated intracardiac anomalies and significant left-to-right shunt can be managed conservatively with periodic follow-up. Transcatheter closure of PDA in a case of the right aortic arch with isolated left subclavian has also been reported.…”

Isolation of the right subclavian artery in a patient with d-transposition of the great arteries

“…Of note, isolated brachiocephalic arteries have also been described, which can be explained by an interruption in the arch distal to the ductus arteriosus and a second interruption proximal to the common carotid artery. [ 10 ]…”