d-transposition of great arteries, dextrocardia with aberrant origin of right subclavian artery from pulmonary artery

Diagnosis of anomalous origin of the right subclavian artery from the right pulmonary artery in a patient with D‐transposition of the great arteries utilizing transthoracic echocardiography

“…Alternatively, reports have described ASO with subclavian artery re-implantation to the systemic circulation, usually the aorta or common carotid. 1,3 Although this is more physiologic, the mobilization of the subclavian artery is technically challenging and there is an increased risk of restenosis. In our patient's case, because of technical F I G U R E 1 (1) d-TGA: aorta is seen arising anterior to the pulmonary artery with a left aortic arch; first branch of the aortic arch is the right common carotid artery; second branch is the left common carotid artery; third branch is the left subclavian artery, (2) AORSA: right subclavian artery arises from the proximal RPA and has a superior and leftward course with close proximity to the distal ascending aorta before finally coursing rightward, (3) large left-sided PDA.…”

“…Some reports have described surgical correction with ASO with subclavian artery ligation and division from the RPA (our patient), 2,4 but this carries the risk of subclavian steal syndrome where the subclavian artery is supplied by the vertebral artery. Alternatively, reports have described ASO with subclavian artery re‐implantation to the systemic circulation, usually the aorta or common carotid 1,3 . Although this is more physiologic, the mobilization of the subclavian artery is technically challenging and there is an increased risk of restenosis.…”

“…[1][2][3][4][5][6] Diagnosis is usually made using computed tomography (CT), MRI, or invasive angiography. 1,3,4,6 We report a patient with d-TGA who presents with unusual differential cyanosis, raising concerns of aortic arch anomalies, who was subsequently diagnosed with AORSA using transthoracic echocardiography (TTE). This case demonstrates the importance of considering aortic arch anomalies in d-TGA when patients do not show reverse differential cyanosis.…”

“…Anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery (RPA) is extremely rare in dextro‐transposition of the great arteries (d‐TGA). Only a few cases have been reported 1–6 . Diagnosis is usually made using computed tomography (CT), MRI, or invasive angiography 1,3,4,6 .…”

“…Only a few cases have been reported 1–6 . Diagnosis is usually made using computed tomography (CT), MRI, or invasive angiography 1,3,4,6 . We report a patient with d‐TGA who presents with unusual differential cyanosis, raising concerns of aortic arch anomalies, who was subsequently diagnosed with AORSA using transthoracic echocardiography (TTE).…”