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

Arunamata, Alisa; Perry, Stanton B.; Kipps, Alaina K.; Vasanawala, Shreyas S.; Axelrod, David M.

doi:10.4103/0974-2069.154154

Cited by 12 publications

(24 citation statements)

References 9 publications

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“…The presence of an isolated right SCA arising from the pulmonary artery in association with transposition of great arteries is extremely unusual, with only a few cases reported previously. [11][12][13] The diag- SCA. To the best of our knowledge, there are 10 cases of isolated left CCA described in the literature, all having a right-sided aortic arch and aberrant left SCA.…”

Section: Association With Transposition Of Great Arteriesmentioning

confidence: 99%

“…Note is also made of a circumflex arch (*). AA, ascending aorta; DTA, descending thoracic aorta; LCCA, left common carotid artery; LSCA, left subclavian artery; MPA, main pulmonary artery; RCCA, right common carotid artery lower saturation/deeply cyanotic appearance, is diagnostic of a right SCA arising from the pulmonary artery 11. The ability to make a de-finitive diagnosis based solely on echocardiography, in the absence of this clinical knowledge, is limited.…”

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confidence: 99%

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Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography

et al. 2020

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Aim: To evaluate the imaging characteristics and associations in patients with isolation of arch vessels on multidetector computed tomography angiography (CTA). Materials and Methods: We retrospectively reviewed all multidetector CTA studies performed for the evaluation of congenital heart diseases (CHDs) at our institution from January 2014 to June 2020. Cases with isolation of arch vessels were identified. The isolated arch artery and its relationship with patent arterial duct, pulmonary artery, and aortic arch were characterized in addition to other associated intra-and extracardiac anomalies. Results: Isolation of arch vessels was seen in 14/3926 (0.36%) patients. Left subclavian artery (SCA) was the commonest isolated arch vessel, involved in 7/14 (50%) cases. Isolation of right SCA, left brachiocephalic artery, and left common carotid artery was seen in 4 (28.6%), 2 (14.3%), and 1 (7.1%) patient, respectively. The isolated arch vessel was seen associated with right aortic arch in 10/14 (71.4%) cases and was on the opposite side of aortic arch in all 14 (100%) patients. Right-sided nonrestrictive patent arterial duct was seen in 3/14 (21.4%) cases, left-sided nonrestrictive patent arterial duct was seen in 1/14 (7.1%) while a left-sided restrictive patent arterial duct was seen in 3/14 (21.4%) cases. Tetralogy of Fallot (ToF) was the commonest associated anomaly seen in 8/14 (57.1%) patients. Conclusion: Isolation of aortic arch branch vessels is rare, seen most commonly associated with ToF. Left SCA is the commonest involved vessel. CTA is useful not only in the diagnosis of isolation of arch vessels, but also in the presence or absence of associated anomalies which may impact the symptomatology, prognosis, and surgical management.

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Section: Association With Transposition Of Great Arteriesmentioning

confidence: 99%

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confidence: 99%

Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography

et al. 2020

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“…In the presented case, unusual differential cyanosis led to the diagnosis of an isolated RSCA in a newborn with D-TGA. The combination of a D-TGA with an isolated RSCA has only been reported in a few cases [ 1 , 2 ]. However, this vascular anomaly can have significant influence on the management and therapy of these children.…”

Section: Discussionmentioning

confidence: 99%

A Cyanotic Newborn with a Pink Right Upper Extremity

Beichl

Zimpfer

Rittenschober-Böhm

et al. 2020

Case Reports in Pediatrics

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Aberrant origin of the subclavian artery (SCA) is a well-known vascular anomaly as part of congenital heart diseases with the left subclavian artery (LSCA) being more frequently affected than the right subclavian artery (RSCA). Complete isolation of the SCA is an even more infrequent aortic arch anomaly, occurring in less than 1% for the LSCA and even less for the RSCA. Isolation of the RSCA in patients with d-transposition of the great arteries (D-TGA) is even scanter with only a hand full of cases being reported in the literature. However, isolation of the RSCA has important implications on hemodynamics and surgical strategies. In this case report, we present a newborn patient with D-TGA which presented with distinct differential cyanosis. While the right upper extremity appeared pink with an oxygen saturation of 100%, the rest of the body was cyanotic. At first, this appearance was interpreted as the Harlequin phenomenon during primary care. However, detailed echocardiography revealed an aberrant origin of the RSCA from the right pulmonary artery, which led to the differential cyanosis. The patient underwent arterial switch operation on day of life two including dissection and reimplantation of the RSCA. The special hemodynamic situation of this is discussed in terms of pathophysiology and as well as its impact on perioperative and surgical management.

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“…Therefore, further imaging modalities such as computed tomography, magnetic resonance imaging, or angiography should be recommended when a patient shows an unexpected saturation pattern. Techniques for managing this condition include simple ligation of the subclavian artery and surgical reimplantation of the RSCA [8].…”

Section: Discussionmentioning

confidence: 99%

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

Park

Song

Huh

et al. 2018

Korean J Thorac Cardiovasc Surg

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This case report concerns a young patient with an extremely rare combination of d-transposition of the great arteries (d-TGA) and anomalous origin of the right subclavian artery. In our patient, the right subclavian artery originated from the pulmonary artery, which is why he did not show reversed differential cyanosis. We conclude that the presence of an aortic arch anomaly should be considered in patients with d-TGA who do not present with reversed differential cyanosis. A further imaging work-up, including computed tomography or magnetic resonance imaging, might be helpful.

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

Cited by 12 publications

References 9 publications

Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography

Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography

A Cyanotic Newborn with a Pink Right Upper Extremity

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

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