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Angiograms demonstrating anomalous origin of the left common carotid artery from the main pulmonary artery. (a) Aortic arch injection demonstrating a right aortic arch with the right common carotid artery arising from the transverse arch. The main pulmonary artery fills via the patent ductus arteriosus, and the left common carotid artery origin form the main pulmonary artery is also seen. (b and c) Anteroposterior and lateral projections demonstrating the left common carotid artery arising from the superior portion of the main pulmonary artery near the bifurcation. (d) Left subclavian injection with retrograde flow seen in the left common carotid artery
Source publication
Isolation of the left common carotid artery (LCCA) is a very rare congenital aortic arch anomaly. We present this finding in a female infant with pulmonary atresia and intact ventricular septum, with a clinical diagnosis of CHARGE syndrome. Cardiac catheterization revealed an anomalous origin of the LCCA from the pulmonary trunk, with retrograde fi...
Contexts in source publication
Context 1
... ascending aorta angiogram revealed a right aortic arch with abnormal head vessel branching, including an aberrant left subclavian artery. In addition, the left common carotid artery (LCCA) could not be seen arising from the aortic arch [ Figure 1a]. There was a left-sided arterial duct that was long and somewhat tortuous. ...
Context 2
... patients, where the supply of the isolated head vessel is not as clearly delineated, then further cerebral vascular assessment may be warranted. Our patient underwent carotid ligation with cerebral oxygen consumption monitoring through near-infrared portion of the pulmonary trunk near the site of bifurcation [ Figure 1b and c]. A selective left subclavian angiogram showed a normal left vertebral artery and retrograde filling of the LCCA into the pulmonary trunk [ Figure 1d]. ...
Context 3
... patient underwent carotid ligation with cerebral oxygen consumption monitoring through near-infrared portion of the pulmonary trunk near the site of bifurcation [ Figure 1b and c]. A selective left subclavian angiogram showed a normal left vertebral artery and retrograde filling of the LCCA into the pulmonary trunk [ Figure 1d]. ...
Citations
... However, isolation of an aortic arch vessel from the remainder of the aortic system, with the vessel instead arising from the pulmonary arterial tree, is quite rare and often involves the brachiocephalic or subclavian arteries. A search of the literature disclosed only 14 cases of isolated left common carotid artery (CCA) (5)(6)(7)(8)(9), with a single case report of isolation of the right internal carotid artery (10). To our knowledge, we report the first case of isolated right CCA. ...
... Isolation of the left CCA would result from regression of the proximal and mid left aortic arches with persistence of the left ductus supplying the left CCA, also resulting in a right aortic arch and aberrant left subclavian artery. Consistent with this, all 14 previously reported cases of isolation of the left CCA also demonstrate right aortic arch with aberrant left subclavian artery (5)(6)(7)(8)(9). ...
Isolated aortic arch vessels arising anomalously from the pulmonary arterial system are rare congenital anomalies. Case reports of isolated arch vessels are often associated with 22q11 deletion, CHARGE syndrome, or right aortic arch. Isolation of the carotid artery may lead to cerebral steal phenomenon and ischemia or to pulmonary overcirculation. The authors report what is, to their knowledge, the first case of isolated right common carotid artery arising from the right pulmonary artery, associated with 22q11 deletion, and describe the challenging multimodality image evaluation. Keywords: Congenital, Anatomy, Carotid Arteries © RSNA, 2022.
... A common carotid artery has been reported to originate from the pulmonary artery; however, this is highly uncommon. Among the eight patients previously reported, one had atrial septal defect [Fong 1987], one had ventricular septal defect [Cohen 2019], two had tetralogy of Fallot [Huang 1996;Kaushik 2005], three had no congenital heart disease [Fouilloux 2013;Hurley 2008;Tozzi 1989], and only one had CHARGE syndrome [Osakwe 2016]. We report a scarce case of transcatheter closure of patent ductus arteriosus for five years with occasional dizziness lasting two months. ...
Background:
The anomalous origin of the left common carotid artery from the pulmonary artery is extremely scarce. At present, there are few relevant research and medical treatment data. This case is intended to provide relevant information and share treatment experiences. Case information: A 6-year-old child was diagnosed with patent ductus arteriosus and underwent surgery five years ago with occasional dizziness. After examination, it was found that the abnormality of her left common carotid artery originated from the pulmonary artery, and the patient underwent arterial ligation with the monitoring of cerebral oxygen consumption by near-infrared spectroscopy after careful preoperative evaluation. At present, it has been two years after the operation, and the patient is in good condition and has received regular follow-up.
Conclusion:
For patients with an abnormal left common carotid artery from the pulmonary artery, after careful preoperative evaluation such as cerebral angiography, under the monitoring of cerebral oxygen consumption by near-infrared spectroscopy, ligation of the proximal end of the artery of abnormal origin is safe and feasible.
... The isolated carotid artery is the rarest form of arch vessel isolation, with only 15 cases reported thus far. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Surgical reimplantation of the isolated carotid artery is the preferred option. Nonetheless, the risk of post-operative cerebral hyperperfusion syndrome mandates careful preoperative evaluation and perioperative management. ...
... However, the presence of independent ipsilateral arterial duct or ductal ligament in 9 out of 15 reported cases (60%) as well as in the index case makes the connection between isolated carotid artery with the pulmonary artery unlikely to be via an arterial duct. 3,7,9,10,[12][13][14][15][16] Some authors have proposed an alternative hypothesis of malseptation of the trunco-aortic sac to explain the isolation of the aortic arch artery, especially the carotid artery. 6,9,16,19 Although not reported previously, the coexistence of anomalous origin of right coronary artery from the isolated left common carotid artery in our case also favours the theory of malseptation of the trunco-aortic sac (Fig 9). ...
... 4,6,7,9,11,16 Nonetheless, in 4 patients, the lower end of the isolated carotid artery was closed (Table 1). 2,3,13,15 Although the lower end of the isolated carotid artery can be closed using an occluder device, surgical ligation is preferred as it would also permit ligation and release of arterial duct or ductal ligament. 14 Two infants underwent concomitant aorta-pulmonary shunt for TOF/ pulmonary atresia. ...
An isolated carotid artery is a rare aortic arch anomaly. Instead of connecting to the aorta, the isolated carotid artery connects anomalously to the pulmonary artery. Chronically altered cerebral circulation poses the risk of cerebral hyperaemia following surgical reimplantation. We describe successful reimplantation of the isolated left common carotid artery in a child, highlighting the importance of a multidisciplinary approach for good clinical and neurological outcomes. We also briefly discuss the embryologic basis of this rare arch anomaly.
... The presence of an isolated right SCA arising from the pulmonary artery in association with transposition of great arteries is extremely unusual, with only a few cases reported previously. [11][12][13] The diag- 18 Embryologically, there is a regression between the seventh cervical intersegmental artery and CCA on the left side so that the SCA is connected to the dorsal aorta. The isolation of CCA, however, cannot be explained solely based on Edward′s hypothetical arch. ...
... In another series, 30% of the reported cases of isolated left CCA also had no other intracardiac anomaly. 18 ...
Aim
To evaluate the imaging characteristics and associations in patients with isolation of arch vessels on multidetector computed tomography angiography (CTA).
Materials and Methods
We retrospectively reviewed all multidetector CTA studies performed for the evaluation of congenital heart diseases (CHDs) at our institution from January 2014 to June 2020. Cases with isolation of arch vessels were identified. The isolated arch artery and its relationship with patent arterial duct, pulmonary artery, and aortic arch were characterized in addition to other associated intra‐ and extracardiac anomalies.
Results
Isolation of arch vessels was seen in 14/3926 (0.36%) patients. Left subclavian artery (SCA) was the commonest isolated arch vessel, involved in 7/14 (50%) cases. Isolation of right SCA, left brachiocephalic artery, and left common carotid artery was seen in 4 (28.6%), 2 (14.3%), and 1 (7.1%) patient, respectively. The isolated arch vessel was seen associated with right aortic arch in 10/14 (71.4%) cases and was on the opposite side of aortic arch in all 14 (100%) patients. Right‐sided nonrestrictive patent arterial duct was seen in 3/14 (21.4%) cases, left‐sided nonrestrictive patent arterial duct was seen in 1/14 (7.1%) while a left‐sided restrictive patent arterial duct was seen in 3/14 (21.4%) cases. Tetralogy of Fallot (ToF) was the commonest associated anomaly seen in 8/14 (57.1%) patients.
Conclusion
Isolation of aortic arch branch vessels is rare, seen most commonly associated with ToF. Left SCA is the commonest involved vessel. CTA is useful not only in the diagnosis of isolation of arch vessels, but also in the presence or absence of associated anomalies which may impact the symptomatology, prognosis, and surgical management.
