title: Perioperative care of an infant with an anomalous left innominate artery arising from the main pulmonary artery.
abstract: A 1.4-kilogram, male infant was born at 27 weeks gestation at an outside hospital. After birth, the patient's trachea was intubated and surfactant administered. Initial echocardiogram showed a patent ductus arteriosus (PDA) and a ventricular septal defect (VSD), with a possible aberrant vessel arising from the carotid artery. The patient was transferred to our hospital for further management. Repeat echocardiogram showed a right aortic arch with the left common carotid/innominate artery arising from the pulmonary artery. The infant was subsequently brought to the operating room where following sternotomy, the aberrant left innominate artery was reimplanted into the aorta. The origin of the left carotid artery or innominate artery from the pulmonary artery is an extremely rare form of congenital heart disease with a limited number of reports in the literature. The differential pressure gradient between the systemic and pulmonary beds may lead to a steal phenomenon, with shunting of blood from the carotid system into the pulmonary vascular bed, resulting in decreased cerebral blood flow. The left-to-right shunting from the systemic to pulmonary bed may also lead to volume overload of the left side of the heart. In the perioperative care of such patients, control of physiologic factors that control the balance between the pulmonary and systemic vascular resistance is mandatory to ensure that cerebral blood flow is maintained.
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA. aymen.naguib@natiowidechildrens.org
authors.forename: Aymen N
authors.initials: AN
authors.lastname: Naguib
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Corridore
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Alistair
authors.initials: A
authors.lastname: Phillips
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Olshove
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D016122:Brachiocephalic Trunk / Q000002:abnormalities*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D017536:Carotid Artery, Common / Q000002:abnormalities*; D004452:Echocardiography; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D018810:Magnetic Resonance Angiography; D008297:Male; D016343:Monitoring, Intraoperative; D019990:Perioperative Care / Q000379:methods*; D011651:Pulmonary Artery / Q000002:abnormalities*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*