Interrupted Right Sided Aortic Arch With Left Hemitruncus And Bilateral Ducts
Ankavipar Saprungruang, MD, Safwat Aly, MD, Shi-Joon Yoo, MD, David J. Barron, MD, Conall Thomas Morgan, MD.
The Hospital for Sick Children, TORONTO, ON, Canada.
The term female presented with differential cyanosis on the first day of life (pre and post-ductal saturations of 92% and 88%). The echocardiogram and CT showed interrupted right sided aortic arch with anomalous origin of the left pulmonary artery from the ascending aorta (hemitruncus), anomalous origin of the left subclavian artery from a left patent ductus arteriosus, and large perimembranous VSD. A Single-stage repair was safely performed with aortic arch reconstruction, closure of the VSD, reimplantation of the LPA to the MPA and ligation of the origin of the LSCA. The challenge of surgery is the competing tensions to both leftward and rightward directions on the ascending aorta, that were overcome by reconstructing the arch to the right and disconnecting the LSCA with correction of the left hemitruncus. At three months post operatively the infant was clinically well and the follow-up CT revealed unobstructed aortic arch, normal biventricular function but significant proximal LPA stenosis that was successfully percutaneously dilated in the cardiac catheterization lab.
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