A rare anatomic variation: a combination of anomalous origin of the right subclavian artery from the main pulmonary artery, ventricular septal defect, and aortic coarctation.
BACKGROUND
We present a rare case of an anomalous origin of the right subclavian artery (SA) from the pulmonary artery (PA) associated with ventricular septal defect (VSD) and aortic coarctation.


METHODS
Critical aortic coarctation and VSD were diagnosed in a neonate, and coarctation angioplasty was successfully performed. Severe cardiac failure developed after this procedure, however, and closure of the VSD was planned.


RESULTS
The anomalous SA was diagnosed during the operation when the cardiopulmonary bypass was initiated. As the pulmonary blood flow decreased, a difference in pulse pressures between the right radial artery and the ascending aorta was noticed to be due to the subclavian steal phenomenon. The difference decreased from 60 mm Hg to 25 mm Hg following ligation of the SA at its origin from the PA. The patient was discharged on the eighth postoperative day without any problems.


CONCLUSIONS
An abnormal origin of the right SA from the main PA associated with VSD and aortic coarctation is a unique combination that, if unnoticed preoperatively, may create difficulties during the operation.
Vuran
Can
C
Department of Cardiovascular Surgery, Baskent University Istanbul Hospital, Istanbul, Turkey. canvuran@hotmail.com
Omay
Oguz
O
Ayabakan
Canan
C
Kocyigit
Ozgen Ilgaz
OI
Yoruker
Uygar
U
Turkoz
Riza
R
D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D013348:Subclavian Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography