Right Aortic Arch and Isolated Left Subclavian Artery: Prenatal and Postnatal Echocardiographic and Tomographic Imaging

Abstract

Graphical abstract

Isolated Left Subclavian Artery Associated with Right Aortic Arch: A Case Report

“…The LSCA is disconnected from the aorta and connected to the pulmonary artery through the ductus arteriosus, which may be patent or closed [11,12]. The left vertebral artery supplies blood retrogradely to the LSCA, which may also be supplied by mediastinal or thoracic collateral vessels [6,10,13]. The majority of patients with isolated left subclavian artery having an association with another congenital heart disease [1,3].…”

“…Patients may present with a subclavian steal syndrome secondary to vertebrobasilar insufficiency and manifesting as paroxysmal vertigo, headache, or syncope [14,15]. They may also present with symptoms related to the hypoperfusion of the left upper limb, such as paresthesia, coldness, pain, weakness, or even hypotrophy of the limb [6,10,13].…”

“…Transthoracic echography is the first-line investigation, it can show the right aortic arch with the subclavian artery isolated, in addition, it allows making the hemodynamic study, and if it is performed early, it allows seeing the PDA. CT scan angiography and MRI can be the second-line imaging modalities especially after the closure of ductus arteriosus, to better delineate the course and connections of the LSCA [5,6].…”

“…For asymptomatic patients, surgical treatment is discussed on a case-by-case basis depending on the benefits and risks [14,15]. Regular monitoring may be the strategy of choice, but when surgical treatment is indicated; the preferred approach is reimplantation of the subclavian artery, either through anastomosis or autologous saphenous vein graft placement, to the aortic root or the common carotid artery [5,6,10].…”

“…Isolated left subclavian artery (ILSA) with right aortic arch is a rare association with an incidence of 0.8% in all right-sided aortic arch anomalies [4,5]. It is typically associated with other congenital heart diseases, and clinical manifestations are variable [6].…”