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Ann Thorac Surg 1993;55:600-602
© 1993 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
b Department of Paediatrics, National Heart and Lung Institute, Royal Brompton National Heart and Lung Hospitals, London, United Kingdom
Accepted for publication June 1, 1992.
* Address reprint requests to Dr Mill, CB 7065, 108 Burnett-Womack Building, Chapel Hill, NC 27599-7065.
An anomalous course of the left brachiocephalic vein beneath the aortic arch was identified in 7 patients undergoing surgical repair of congenital cardiac malformations. Six of these patients had the morphologic features of tetralogy of Fallot including severe obstruction to the right ventricular outflow tract and a right aortic arch. A review of the literature reveals this to be an uncommon anomaly. When it is present, however, it is frequently associated with a ventricular septal defect, obstruction of the right ventricular outflow, and aortic arch anomalies. This anomaly can be documented by echocardiography, at cardiac catheterization, or intraoperatively. The presence of a subaortic left brachiocephalic vein may have implications for the conduct of surgical procedures, especially in the setting of tetralogy of Fallot.
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