Ann Thorac Surg 2008;86:1697. doi:10.1016/j.athoracsur.2008.01.063
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Isolated Left Subclavian Artery
Stefano Schena, MD, PhD,
Sanjiv K. Gandhi, MD*
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
* Address correspondence to Dr Gandhi, Division of Cardiothoracic Surgery, St. Louis Children's Hospital, 1 Children's Place, Ste 5S 50, St. Louis, MO 63110 (Email: gandhis{at}wustl.edu).
A 2-year-old boy was evaluated for a systolic murmur and was found to have a persistent patent ductus arteriosus by transthoracic echocardiogram. On the basis of this diagnosis, he underwent elective cardiac catheterization and coil embolization of the ductus.
The aortogram, however, unexpectedly showed a right-sided aortic arch with only 2 main branching arch vessels: a right subclavian artery (R SCA) and a common trunk (CT) giving rise to both the right and left common carotid arteries. A large aortopulmonary collateral (APC) vessel connecting the two circulatory systems was also evident. No left subclavian artery was seen arising from the aorta (Fig 1A).
An interesting finding was that despite no residual flow through the patent ductus arteriosus after coiling, late contrast enhancement of the main pulmonary artery (MPA) was still evident, suggesting the presence of a separate collateral from the arterial circulation to the pulmonary artery. A large collateral vessel from the descending aorta was identified feeding a nest of vessels in the left infraclavicular area, with subsequent late filling of the left subclavian artery (L SCA), originating from the main pulmonary artery (Fig 1B).
Because of this finding, the patient underwent surgical exploration (Fig 1C) and, after careful identification of the vagus nerve (VN), reimplantation of his left subclavian artery to the left carotid artery in end-to-side fashion. His postoperative course was uneventful, and he was discharged home 2 days later.
