Background:
Isolation of Left Subclavian Artery (LSCA) is a rare subset of Right Aortic Arch
(RAA). It is diagnosed as nonvisualization of LSCA in catheterization study. Case
Presentation:Here we report an unusual case of Tetralogy of Fallot
(TOF) with right aortic arch with isolation of left subclavian artery (LSCA).
Here LSCA originated from left pulmonary artery (LPA) through an atretic patent
ductus arteriosus (PDA). There was nonvisualization of LSCA in catheterization
study and it was confirmed by Computed Tomography (CT) angiography.
Re-implantation of LSCA was done to left common carotid artery (LCCA) so that
the left upper arm maintains a better flow in
the future. Conclusion: Isolation of LSCA especially with TOF is a very rare entity.
Re-implantation of LSCA to LCCA was done in view of weak pulses in left upper
limb. Results were satisfactory in the follow up period.
References
[1]
Nath, P.H., Castaneda-Zuniga, W., Zollikofer, C., et al. (1981) Isolation of a Subclavian Artery. American Journal of Roentgenology, 137, 683-688.
https://doi.org/10.2214/ajr.137.4.683
[2]
Stewart, J.R., Kincaid, O.W. and Titus, J.L. (1966) Right Aortic Arch: Plain Film Diagnosis and Significance. American Journal of Roentgenology, 97, 377-389.
https://doi.org/10.2214/ajr.97.2.377
[3]
Leutmer, P.H. and Miller, G.M. (1990) Right Aortic Arch with Isolation of the Left Subclavian Artery: Case Report and Review of the Literature. Mayo Clinic Proceedings, 65, 407-413. https://doi.org/10.1016/S0025-6196(12)62540-3
[4]
Edwards, J.E. (1948) Anomalies of the Derivatives of the Aortic Arch System. Medical Clinics of North America, 32, 925-949.
https://doi.org/10.1016/S0025-7125(16)35662-0
[5]
Mangukia, C., Sethi, S., Agarwal, S., Mishra, S. and Satsangi, D.K. (2014) Right Aortic Arch with Isolation of the Left Innominate Artery in a Case of Double Chamber Right Ventricle and Ventricular Septal Defect. Annals of Pediatric Cardiology, 7, 148-151. https://doi.org/10.4103/0974-2069.132500
[6]
McMahon, C.J., Thompson, K.S., Kearney, D.L. and Nihill, M.R. (2001) Subclavian Steal Syndrome in Anomalous Connection of the Left Subclavian Artery to the Pulmonary Artery in d-Transposition of the Great Arteries. Pediatr Cardiol, 22, 60-62. https://doi.org/10.1007/s002460010155
[7]
Ghon, A. (1908) Ueber eine seltene Entwicklungs-storung des Gefassystem. Verh Dtsch Ges Pathol, 12, 242-247.
[8]
Lee, C., Kim, T.S., Lee, C.H. and Kim, S.J. (2010) Incomplete Isolation of the Left Innominate Artery in a Patient with Right Aortic Arch and Double Outlet Right Ventricle. Journal of Cardiac Surgery, 25, 232-234.
https://doi.org/10.1111/j.1540-8191.2009.00978.x
[9]
Gil-Jaurena, J.M., Ferreiros, M., Zabala, I. and Cuenca, V. (2011) Right Aortic Arch with Isolation of the Left Innominate Artery Arising from the Pulmonary Artery and Atrial Septal Defect. The Annals of Thoracic Surgery, 91, 303.
https://doi.org/10.1016/j.athoracsur.2010.06.015
[10]
Jones, T.K., Garabedian, H. and Grifka, R.G. (1999) Right Aortic Arch with Isolation of the Left Subclavian Artery, Moderate Patent Ductus Arteriosus, and Subclavian Steal Syndrome: A Rare Aortic Arch Anomaly Treated with the Gianturco-Grifka Vascular Occlusion Device. Catheterization and Cardiovascular Interventions, 47, 320-322.
https://doi.org/10.1002/(SICI)1522-726X(199907)47:3<320::AID-CCD15>3.0.CO;2-V
