Left Common Carotid Artery Isolation in a Newborn With Tetralogy of Fallot and DiGeorge Syndrome

Abstract

HomeCirculationVol. 111, No. 1Left Common Carotid Artery Isolation in a Newborn With Tetralogy of Fallot and DiGeorge Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBLeft Common Carotid Artery Isolation in a Newborn With Tetralogy of Fallot and DiGeorge Syndrome Guido Oppido, MD, Carlo Pace Napoleone, MD, Davide Gabbieri, MD, Alessandro Giardini, MD, Roberto Formigari, MD, Sofia Martin-Suarez, MD, Fernando M. Picchio, MD and Gaetano Gargiulo, MD Guido OppidoGuido Oppido From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Carlo Pace NapoleoneCarlo Pace Napoleone From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Davide GabbieriDavide Gabbieri From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Alessandro GiardiniAlessandro Giardini From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Roberto FormigariRoberto Formigari From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Sofia Martin-SuarezSofia Martin-Suarez From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author , Fernando M. PicchioFernando M. Picchio From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author and Gaetano GargiuloGaetano Gargiulo From the Departments of Pediatric Cardiac Surgery (G.O., C.P.N., D.G., S.M.-S., G.G.) and Pediatric Cardiology (A.G., R.F., F.M.P.), S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. Search for more papers by this author Originally published4 Jan 2005https://doi.org/10.1161/01.CIR.0000151515.56867.76Circulation. 2005;111:e4–e5A 2.8-kg newborn girl was referred to our hospital for tetralogy of Fallot with a right aortic arch. ECG failed to provide a clear anatomic definition of the pulmonary blood supply. Cardiac catheterization disclosed a right aortic arch giving rise to 4 separate branches in the following sequence: right common carotid artery, right vertebral artery, right subclavian artery, and aberrant left subclavian artery (Figure 1). An isolated left common carotid artery, draining into the left pulmonary artery, was visualized by retrograde filling after selective injection into the right common carotid artery (Figure 2). Such a rare anomaly creates a left-to-right shunt at the arterial level, which becomes more significant when the pulmonary artery pressure lowers because of spontaneous or surgical right ductal closure. Isolation of the common carotid artery occurs only when the homolateral subclavian artery is aberrant so that the innominate artery cannot be formed. Download figureDownload PowerPointFigure 1. Aortic arch angiography. Four branches arise from the aortic arch: right common carotid artery (RCCA), right vertebral artery (RVA), right subclavian artery (RSA), and aberrant left subclavian artery (LASA). The right common carotid artery is not visualized. The pulmonary arteries (LPA, left; RPA, right) are visualized through the patent right ductus (*).Download figureDownload PowerPointFigure 2. Selective RCCA angiography. The isolated left common carotid artery (LCCA), draining into the LPA through a patent left ductus arteriosus (LDA), is clearly visualized by retrograde filling.A bilateral patent ductus arteriosus connected the aortic isthmus to the right pulmonary artery and the isolated vessel to the left pulmonary artery. The main pulmonary artery and its branches were confirmed to be moderately and diffusely hypoplastic. Anomalous origin of the left anterior descending coronary artery from the right coronary artery was visualized.Via median sternotomy (Figure 3), the baby underwent aortic arch implantation of the isolated left carotid artery and 3-mm polytetrafluoroethylene systemic-to-pulmonary shunt interposition between the ascending aorta and the left pulmonary artery (Figure 4). Complete repair was deferred because of the coronary anomaly and the small size of the pulmonary arteries. The thymic gland was absent, thus supporting the clinical findings typical of DiGeorge syndrome. The patient survived the operation and is currently awaiting complete repair. Download figureDownload PowerPointFigure 3. Intraoperative view. Isolated LCCA (white arrow) and LDA. Ao indicates aorta.Download figureDownload PowerPointFigure 4. Intraoperative view. The isolated LCCA (white arrow) has been implanted in the aortic arch after the LDA tissue had been completely removed to avoid potential retraction. A 3-mm polytetrafluoroethylene shunt has been created between the ascending aorta and the main pulmonary artery.FootnotesCorrespondence to Guido Oppido, MD, Department of Pediatric Cardiac Surgery, S. Orsola-Malpighi Hospital, Via Massarenti, n.9, 40138 Bologna, Italy. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Juergensen S, Quezada E, Silverman N, Gossett J, Kouretas P, Reddy V and Hogan W (2021) Breaking the Rules: Left Common Carotid Artery from the Main Pulmonary Artery in an Infant with a Vascular Ring, CASE, 10.1016/j.case.2021.07.011, 5:5, (262-266), Online publication date: 1-Oct-2021. Vignaroli W, Curione D, Perri G, Secinaro A, Filippelli S and Iorio F (2020) Anomalous Origin of Left Common Carotid Artery From Left Pulmonary Artery in a 22q11.2 Deletion Syndrome Newborn With Right Aortic Arch and Aberrant Left Subclavian Artery, Circulation: Cardiovascular Imaging, 13:3, Online publication date: 1-Mar-2020. Matsuo K, Aoki H and Kayatani F (2019) The closing process of the ductus arteriosus connecting the left common carotid artery and main pulmonary artery, Cardiology in the Young, 10.1017/S1047951118002275, 29:3, (422-424), Online publication date: 1-Mar-2019. 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Männer J (2013) Isolated Left Common Carotid Artery Arising From the Main Pulmonary Artery, World Journal for Pediatric and Congenital Heart Surgery, 10.1177/2150135113502058, 4:4, (460-461), Online publication date: 1-Oct-2013. Sachdeva S, Gupta S, Rajashekar P, Jagia P and Devarajan Sebastian L (2022) Isolated left common carotid artery: multidisciplinary management is the key to success, Cardiology in the Young, 10.1017/S1047951121005308, (1-8) January 4, 2005Vol 111, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000151515.56867.76PMID: 15630032 Originally publishedJanuary 4, 2005 PDF download Advertisement SubjectsAngiographyCardiovascular SurgeryCongenital Heart DiseaseDevelopmental BiologyImaging