Interrupted Aortic Arch With Bilateral Ductus Arteriosi and Bilateral Aberrant Subclavian Arteries
A newborn infant presented with tachypnea, cyanosis, and diminished pulses in all extremities. An initial echocardiogram suggested an interrupted aortic arch (type B) with aberrant left subclavian artery, restrictive left sided patent ductus arteriosus, and a right-sided descending thoracic aorta. The aortic valve was bicommissural (6 mm annulus). There was a large conal septal ventriculoseptal defect and a secundum atrial septal defect. Intravenous prostaglandin E1 was initiated, and bounding pulses returned in all extremities. A contrast-enhanced helical computed tomography scan (Figure 1A and 1B) demonstrated interrupted aortic arch type B with a small ascending aorta giving rise to the left and right common carotid arteries, and bilateral patent ductus arteriosi arising from the main pulmonary artery and coalescing with a right-sided descending thoracic aorta posterior to the trachea and esophagus. The left and right subclavian arteries arose from their respective distal ductal arches just proximal to their convergence with the descending aorta. Chromosome 22q11 deletion was found. This anatomy was confirmed intraoperatively (Figure 2). The left ductal arch was transected. The distal left ductal arch adjacent to the descending aorta was over-sewn. The ascending aorta was opened on its posterior surface, and the right ductal arch was transected just proximal to the right subclavian artery. The descending aorta and right subclavian artery were anastomosed to the ascending aortotomy. The left subclavian artery was anastomosed end-to-side to the left carotid artery (Figure 3A and 3B). The atrial and ventricular septal defects were closed. There were no hemodynamically significant residual lesions.
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