Author + information
- Received February 16, 2010
- Accepted March 9, 2010
- Published online February 8, 2011.
- Joe Kreeger, RDCS, RCCS,
- Brian Schlosser, BS, RDCS, RDCM,
- Denver Sallee, MD,
- William Border, MBChB, MPH and
- Shriprasad Deshpande, MBBS, MS
A 3-month-old patient with a known diagnosis of perimembranous ventricular septal defect and DiGeorge syndrome was admitted for an aspiration event. On admission, transthoracic echocardiography confirmed the known diagnosis of perimembranous ventricular septal defect. Suprasternal aortic arch imaging failed to demonstrate normal innominate artery origin. On careful evaluation, a right-sided aortic arch was noted, with isolated innominate artery originating from the main pulmonary artery (A, Online Videos 1 and 2). The right carotid and right subclavian arteries had normal origins from the aorta. Cardiac magnetic resonance imaging confirmed the diagnosis of isolated innominate artery from the main pulmonary artery (B to D).
Isolated innominate artery from the pulmonary artery is an exceedingly rare anomaly (1,2). There are only 2 previous reports of association with DiGeorge syndrome (3,4). Embryologically, the hypothetical double aortic arch of Edwards can explain the occurrence of isolated innominate artery (E) (5). Clinically, in the absence of an intracardiac shunt, differential cyanosis between the right and left arm should raise the suspicion for this anomaly. In most cases, including ours, the innominate artery can be relocated to the aorta with good results.
- Received February 16, 2010.
- Accepted March 9, 2010.
- American College of Cardiology Foundation