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Sakaki S, Ikegawa T, Kawataki M, Ueda H. Prenatal diagnosis and perinatal clinical course of isolated left-sided innominate artery. Cardiol Young 2024:1-3. [PMID: 38801119 DOI: 10.1017/s1047951124025307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Isolated left-sided innominate artery, a rare congenital anomaly in which the left-sided innominate artery arises from the main pulmonary trunk, is usually diagnosed incidentally in children and adults. Limited reports exist on its prenatal diagnosis, with none comprehensively describing the associated perinatal haemodynamic changes. We report a case of prenatally diagnosed isolated left-sided innominate artery, describing the postnatal clinical course.
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Affiliation(s)
- Shinichiro Sakaki
- Department of Cardiology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Takeshi Ikegawa
- Department of Cardiology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Motoyoshi Kawataki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Kanagawa, Japan
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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Malakan Rad E, Pouraliakbar HR. Isolation of the left brachiocephalic artery revisited: A 52-year literature review and introduction of a novel anatomic-clinical-prognostic classification. Ann Pediatr Cardiol 2019; 12:117-129. [PMID: 31143036 PMCID: PMC6521656 DOI: 10.4103/apc.apc_74_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Isolation of the left brachiocephalic artery (ILBA) is an extremely rare anomaly of aortic arch with diverse manifestations in the neurologic system, heart, and left upper arm. This anomaly is defined as the absence of connection of the left brachiocephalic artery (LBA) to aortic arch and connection of LBA to pulmonary artery (PA) through a patent arterial duct (PAD). However, this definition is not inclusive of all cases. Not only are there inconsistencies in the definition and terminology of this aortic arch anomaly but also there is no classification for this anomaly despite its heterogeneous nature in terms of anatomy, clinical presentation and prognosis. We performed a 52-year comprehensive literature review in the period between 1966 and 2018. Our inclusion criteria were any manuscript that included a case report or case series, with confirmed diagnosis of ILBA. All quantitative data were analyzed using descriptive analysis by SPSS version 21 (IBM SPSS Statistics, USA). Results were presented as mean ± standard deviation and median. Based on the presence or absence of connection of LBA to PA and the number of sources of steal from the LBA, we classified ILBA into three types: single-steal type with no connection of LBA to PA and single source of blood flow steal from LBA through the left subclavian artery (LSCA), double-steal type with connection of LBA to PA through PAD and two sources of steal through LSCA and arterial duct (AD), and triple-steal type with bilateral PADs and therefore, three sources of blood flow steal from LBA including the LSCA and the double ADs. Patients with single-steal type have the best prognosis and present latest with symptoms of cerebrovascular insufficiency or left arm claudication. The oldest reported patient was 69 years of age with symptoms of dizziness and near syncope. No death was reported in these patients. Double-steal type is the most common type and is often associated with genetic syndromes and/or extracardiac anomalies. Triple-steal type is the rarest type with the earliest presentation and worst prognosis. The oldest reported patient was 60 days of age. All reported cases had cardiac symptoms, pulmonary overcirculation, pulmonary hypertension, and fatal outcome.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Hospital Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Penslar J, Menard C, Lee S. Isolated Left Brachiocephalic Artery in Transposition of the Great Arteries. Can J Cardiol 2018; 34:1369.e13-1369.e15. [PMID: 30269835 DOI: 10.1016/j.cjca.2018.07.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
Abstract
Isolation of an artery is a rare congenital defect in which a vessel arises anomalously from the pulmonary arteries rather than the aorta. Isolated left subclavian artery and (less commonly) isolated left brachiocephalic artery have been described in association with various complex congenital heart defects. We present a very unusual case of isolated left brachiocephalic artery associated with transposition of the great arteries. The case suggests that this defect arises from pathological involution of embryologic aortic arches rather than from malseptation.
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Affiliation(s)
- Joshua Penslar
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Catherine Menard
- Department of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Suzie Lee
- Department of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Mangukia C, Sethi S, Agarwal S, Mishra S, Satsangi DK. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect. Ann Pediatr Cardiol 2014; 7:148-51. [PMID: 24987265 PMCID: PMC4070208 DOI: 10.4103/0974-2069.132500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels.
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Affiliation(s)
- Chirantan Mangukia
- Department of Cardio Thoracic and Vascular Surgery, Govind Ballabh Pant Hospital, New Delhi, India
| | - Sonali Sethi
- Department of Radiology, Govind Ballabh Pant Hospital, New Delhi, India
| | - Saket Agarwal
- Department of Cardio Thoracic and Vascular Surgery, Govind Ballabh Pant Hospital, New Delhi, India
| | - Smita Mishra
- Department of Cardiology, Escorts Heart Institute, New Delhi, India
| | - Deepak Kumar Satsangi
- Department of Cardio Thoracic and Vascular Surgery, Govind Ballabh Pant Hospital, New Delhi, India
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Naguib AN, Corridore M, Phillips A, Olshove V, Galantowicz M, Tobias JD. Perioperative care of an infant with an anomalous left innominate artery arising from the main pulmonary artery. J Intensive Care Med 2011; 26:330-4. [PMID: 21320862 DOI: 10.1177/0885066610392673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 1.4-kilogram, male infant was born at 27 weeks gestation at an outside hospital. After birth, the patient's trachea was intubated and surfactant administered. Initial echocardiogram showed a patent ductus arteriosus (PDA) and a ventricular septal defect (VSD), with a possible aberrant vessel arising from the carotid artery. The patient was transferred to our hospital for further management. Repeat echocardiogram showed a right aortic arch with the left common carotid/innominate artery arising from the pulmonary artery. The infant was subsequently brought to the operating room where following sternotomy, the aberrant left innominate artery was reimplanted into the aorta. The origin of the left carotid artery or innominate artery from the pulmonary artery is an extremely rare form of congenital heart disease with a limited number of reports in the literature. The differential pressure gradient between the systemic and pulmonary beds may lead to a steal phenomenon, with shunting of blood from the carotid system into the pulmonary vascular bed, resulting in decreased cerebral blood flow. The left-to-right shunting from the systemic to pulmonary bed may also lead to volume overload of the left side of the heart. In the perioperative care of such patients, control of physiologic factors that control the balance between the pulmonary and systemic vascular resistance is mandatory to ensure that cerebral blood flow is maintained.
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Affiliation(s)
- Aymen N Naguib
- Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Marco Corridore
- Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alistair Phillips
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vincent Olshove
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Galantowicz
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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Lee C, Kim TS, Lee CH, Kim SJ. Incomplete isolation of the left innominate artery in a patient with right aortic arch and double outlet right ventricle. J Card Surg 2010; 25:232-4. [PMID: 20149015 DOI: 10.1111/j.1540-8191.2009.00978.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Isolation of the left innominate artery (IA) with right aortic arch is a rare congenital anomaly in which the IA loses its connection to the aorta and is connected to the pulmonary artery via a left ductus arteriosus. Here, we report a case of a 9-month-old girl with incomplete isolation of the IA and double outlet right ventricle. Along with repair of the intracardiac anomaly, the IA was reimplanted to aortic arch to ensure adequate blood flow from the aorta.
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Affiliation(s)
- Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea.
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Abstract
Right aortic arch with complete isolation of the left brachiocephalic artery is an extremely uncommon anomaly of the aortic arch. This case reports the hitherto unreported association of the right aortic arch with isolated left brachiocephalic artery presenting with a subclavian steal syndrome detected in a 36-year-old female patient being investigated for increasing attacks of episodic dizziness, vertigo, and left upper limb claudication spanning 1 year. A review of the literature relevant to this condition is presented. It is likely that with advances in imaging techniques and a wider clinical usage of these investigative modalities there will be further recognition of these uncommon conditions.
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Affiliation(s)
- B Singh
- Department of Surgery, University of Natal, Congella 4013, South Africa
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Huang SF, Wu MH. Left common carotid artery arising from the pulmonary artery in a patient with DiGeorge syndrome. HEART (BRITISH CARDIAC SOCIETY) 1996; 76:82-3. [PMID: 8774335 PMCID: PMC484433 DOI: 10.1136/hrt.76.1.82] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A female infant, born at 33 weeks' gestation with tetralogy of Fallot, died of severe perinatal asphyxia 6 hours after birth. Necropsy disclosed two associated vascular anomalies: a right aortic arch with a left common carotid artery arising from the pulmonary artery (isolated left common carotid artery) and an aberrant left subclavian artery arising from the descending aorta. Agenesis of the thymus and parathyroid gland was also found, suggesting that the child also had DiGeorge syndrome. Origin of the left common carotid artery from the pulmonary artery is exceedingly rare. When planning surgical treatment it is important to be aware of the possibility of this anomaly occurring in association with congenital heart disease, particularly in the presence of tetralogy of Fallot, right sided aortic arch, or DiGeorge syndrome.
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Affiliation(s)
- S F Huang
- Department of Pathology, College of Medicine, National Taiwan University, Taipei
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Papagiannis J, Kanter RJ, Vander Heide RS, Reimer KA, Ungerleider RM, Van Praagh R. Isolated innominate artery in asplenia syndrome with aortic atresia: newly recognized cardiovascular complex. Am Heart J 1996; 131:1042-4. [PMID: 8615295 DOI: 10.1016/s0002-8703(96)90194-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Papagiannis
- Department of Pathology, Children's Hospital, Boston, MA 02115, USA
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Crump WD, Dische MR, Anthony CL. Right aortic arch, isolated left common carotid and left subclavian arteries, and subclavian steal syndrome: a variant of polysplenia syndrome. Hum Pathol 1981; 12:936-8. [PMID: 7298050 DOI: 10.1016/s0046-8177(81)80200-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Congenital subclavian steal may result from various anomalies of the aortic arch. The most common predisposing type is the right aortic arch with an isolated left subclavian artery arising from a left ductus arteriosus. A rare variant includes isolation of the left common carotid as well as the left subclavian arteries. The case of an infant with polysplenia--F-anisosplenia syndrome and this rare variant of congenital left subclavian steal is presented. This anomalous constellation has been heretofore unreported and illustrates a new situs abnormality that may complicate the polysplenia syndrome.
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