A 60-year-old man without cardiac history underwent angiography to assess the severity of bilateral carotid artery stenosis. A right anterior oblique view of the aortic arch revealed an unusual presentation with a left innominate artery (Figure 1⇓). The left oblique view showed the left innominate artery emerging from the aorta before the right carotid and right subclavian arteries (Figure 2⇓). The front view confirmed the diagnosis of right aortic arch with mirror-image branching and right-sided descending aorta (Figure 3⇓). There was no patent ductus arteriosus. Three-dimensional computer reconstruction of electron-beam CT images confirmed the diagnosis and the lack of vascular ring (Figure 4⇓), explaining why the patient never had stridor or dysphagia. This anomaly is usually associated with a congenital cyanotic heart defect, but in this patient, clinical and echocardiographic examinations were normal.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association