Isolation of the left subclavian artery in an infant with tetralogy of Fallot, right aortic arch and DiGeorge syndrome. Echocardiographic diagnostic case study

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Journal of Ultrasonography

Polish Ultrasound Society (Polskie Towarzystwo Ultrasonograficzne)

Subject: Medicine

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ISSN: 2084-8404
eISSN: 2451-070X

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VOLUME 19 , ISSUE 76 (Apr 2019) > List of articles

Isolation of the left subclavian artery in an infant with tetralogy of Fallot, right aortic arch and DiGeorge syndrome. Echocardiographic diagnostic case study

Maciej A. Karolczak * / Wojciech Mądry / Darren James Grégoire

Keywords : isolated left subclavian artery, tetralogy of Fallot, DiGeorge syndrome, right aortic arch

Citation Information : Journal of Ultrasonography. Volume 19, Issue 76, Pages 66-70, DOI: https://doi.org/10.15557/JoU.2019.0010

License : (CC-BY-SA-4.0)

Received Date : 04-November-2018 / Accepted: 22-January-2019 / Published Online: 30-April-2019

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FIGURES & TABLES

Fig. 1.

Preoperative CT angiography. Ao – ascending aorta, PA – pulmonary trunk, LPA – left pulmonary artery, RAo – right aortic arch, DA – ductus arteriosus, LCCA – left common carotid artery, LVA – left vertebral artery

Fig. 2.

Formation of left-sided aortic arch. RaoG – right dorsal aorta, LAoG – left dorsal aorta, LSA – left subclavian artery (the arrow indicates the direction of its migration), LCA – left carotid artery, III and IV – pharyngeal (aortic) arch arteries, DA – ductus arteriosus, AoS – aortic sac, PA – pulmonary trunk (author’s own scheme – M.A.K)

Fig. 3.

Systole. A round cross-section of the ascending aorta (AoAs) filled with red, and the pulmonary trunk (PA) and the right pulmonary artery (RPA) – blue color. A bulge corresponding to the origin of the left common carotid artery (*) is present in the anterior left contour of the ascending aorta (*)

Fig. 4.

A slightly higher cross-section, diastole. The ascending aorta (AoAsc) is not filled with color. Despite the diastolic phase, the pulmonary trunk (PA) and its two branches (RPA and LPA) are filled with intensive blue color – with distinct turbulence. A bulge corresponding to the outlet of the ductus arteriosus (*) is seen in the anterior contour of the pulmonary trunk (PA). The left common carotid artery is not visible during this phase. VBC – the brachiocephalic vein

Fig. 5.

A further shift of ultrasonic beam upwards, systole. Cross-sections of the ascending aorta (Ao) and the left common carotid artery (LCCA), which runs separately at the same level – both vessels are coded in red – as well as the ductus arteriosus (*) and the pulmonary trunk (PA) – these vessels are filled with blue color, indicative of a flow in the opposite direction

Fig. 6.

Even a higher position of the plane of the beam, systole. Cross-sections of the apical portion of the aortic arch (Ao) and the left common carotid artery (LCCA) filled with red color and the ductus arteriosus (*) filled with blue color. A very close proximity of these vessels is noticeable

Fig. 7.

Systole. The ascending aorta (Ao) branching into the left common carotid artery (LCCA) is shown; both vessels are filled with red color and the initial segment of the aortic arch (AAo – blue color)

Fig. 8.

Systole. Further shift of the ultrasound beam to the left side – two close parallel vessels with opposite directions of flow: the left common carotid artery (LCCA) coded in red and the left subclavian artery with ductus arteriosus coded in blue (LSA + PDA)

Fig. 9.

During diastole, the left subclavian artery/ductus arteriosus (PDA+LSA) are more intensely filled, whereas the red color coding for blood flow in the left common carotid artery disappears. Poorly filled with blue color brachiocephalic vein (BCV) is most superficially seen

Fig. 10.

Postoperative assessment. Visible carotid segments of LCCA and LVA. Systole. The direction of the flow in the left vertebral artery is opposite to the flow in the left common carotid artery

Fig. 11.

Recorded flow in the left vertebral artery using pulse Doppler. Systolic flow. Closure of the ductus arteriosus undoubtedly reduced cerebral steal with maintained perfusion in the left upper extremity

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