Isolated right subclavian artery arising from the right pulmonary artery via a right-sided ductus arteriosus with associated pulmonary steal phenomenon.

We present a patient with DiGeorge syndrome and an isolated right subclavian artery arising from the right pulmonary artery via a right-sided ductus arteriosus. The patient showed a subclavian and pulmonary steal with perfusion of the right arm and right lung via retrograde circulation in the right vertebral artery. The patient underwent successful surgical repair.

Congenital subclavian steal syndrome associated with heterotaxy syndrome and atrioventricular septal defect.

An infant under follow-up evaluation since the fetal stage was detected to have subclavian steal syndrome (SSS) associated with heterotaxy syndrome and atrioventricular septal defect. Such a complex association has not been reported previously. Congenital SSS occurs as a result of a subclavian artery originating from the main pulmonary artery through the ductus instead of the aortic arch. In rare cases, as in the reported case, it may occur due to proximal segment atresia of the left subclavian artery.

Unusual cause of absent pulse in one arm: Isolated subclavian artery.

Isolated origin of the subclavian artery is a congenital anomaly of the aortic arch in which one subclavian artery originates from the homolateral pulmonary artery through the ductus arteriosus. Isolated right subclavian artery with left-sided aortic arch is extremely rare. We report a case of isolated right subclavian artery from the right pulmonary artery via a right-sided ductus arteriosus in a 4-year-old girl. The child presented with subclavian pulmonary steal with perfusion of the right arm and lung from the right vertebral and carotid arteries. She underwent successful surgical repair.

Congenital bilateral subclavian steal: ductus-dependent symptoms in interrupted aortic arch associated with ventricular septal defect.

There are two types of congenital bilateral subclavian steal. The first type is accompanied by severe coarctation or interruption of the aorta in which both the right and left subclavian arteries have their origin distal to the obstruction in the aorta. In most cases with complete interruption of the aorta there is a large ventricular septal defect. The second, less common type of steal is associated with isolated atresia of the proximal segment of the subclavian arteries. In the first type of steal, the anatomic predisposition for the steal is present from birth but clinical symptoms frequently do not appear until childhood or adolescence. In the newborn the presence of a widely patent duclus arteriosus and its capacity to transmit the flow and pressure from a hypertensive pulmonary artery to the descending aorta and thus to the subclavian arteries prevents cerebral symptoms and angiographic signs, but in the older infant and child, the internal diameter of the ductus has usually decreased, leading to symptoms of the subclavian steal syndrome.

Right aortic arch, isolated left common carotid and left subclavian arteries, and subclavian steal syndrome: a variant of polysplenia syndrome.

Congenital subclavian steal may result from various anomalies of the aortic arch. The most common predisposing type is the right aortic arch with an isolated left subclavian artery arising from a left ductus arteriosus. A rare variant includes isolation of the left common carotid as well as the left subclavian arteries. The case of an infant with polysplenia--F-anisosplenia syndrome and this rare variant of congenital left subclavian steal is presented. This anomalous constellation has been heretofore unreported and illustrates a new situs abnormality that may complicate the polysplenia syndrome.

Asymptomatic congenital subclavian steal in a young male patient with right aortic arch.

The clinical and angiographic features of a patient with right aortic arch and isolation of the left subclavian artery from the aorta were described. This young male patient showed no symptoms and signs of the insufficiency of both brain and left-arm blood flow, in spite of the congenital left subclavian steal.

Left subclavian steal, interrupted aortic arch, complete transposition of the great vessels and single left ventricle.

Congenital subclavian steal consists of atresia of the proximal end of the subclavian artery, while the blood supply to the distal portion of the subclavian artery originates from the circle of Willis. It should be suspected in complicated malformations of the heart associated with marked hypoplasia or interruption of the aortic arch. Minimal differences in blood pressure determinations may be an important clue in the diagnosis of this anomaly. The diagnosis may be confirmed by angiography with careful attention to late arterial phase films.

Congenital subclavian aortic steal syndrome: hypoplastic aortic arch with severe coarctation of the aorta of unusual location.

An unusual case of subclavian-aortic steal syndrome in a pediatric patient with hypoplastic aortic arch with coarctation of the aorta of unusual location is described. Aortography showed hypoplasia of the arcus aorta and severe coarctation proximal to the left subclavian artery associated with an aneurysm formation on the isthmus and descending aorta. The enlargement of the arcus aorta was accomplished by prosthetic patch aortoplasty extending from the ascending to descending aorta via median sternotomy using cardiopulmonary bypass and moderate hypothermia. Postoperatively, the patient is doing well with equalized blood pressure.

Subclavian steal syndrome in the pediatric age group.

Four pediatric patients with subclavian steal syndrome (SSS) are described. One patient with congenital SSS had persistence of the lesion following surgical repair of coarctation of the aorta due to a gradient across a hypoplastic aortic arch. In 3 patients SSS developed on an acquired basis as a sequel to corrective operation, for coarctation in 1 patient, and interrupted aortic arch in 2 patients. Contributory factors included hypoplasia of the aortic arch, anatomical variation of the origin of the vertebral artery, and discrete recoarctation involving the ostium of the subclavian artery. Treatment was by vertebral artery ligation in 3 patients and by prosthetic patch arterioplasty in the patient with recoarctation. The 4 patients remain asymptomatic on follow-up of 16 to 25 months.

Congenital subclavian steal syndrome with anomaly of the aortic arch.

A case of congenital subclavian steal syndrome associated with an anomalous right-sided aorta is reported. A 41-year-old man complaining of vertigo and a loss of consciousness was admitted. Physical examination revealed a blood pressure differential between the arms that was 20 mm Hg less in the left. Aortography showed a right aortic arch from which arose the right subclavian and both common carotid arteries. The left subclavian artery did not opacify. Right vertebral angiography showed retrograde filling of the left vertebral. A left carotid-subclavian bypass was performed. Postoperatively, the patient is symptom free with equalized blood pressure.

Extra-anatomical approach to the congenital subclavian steal syndrome.

A young female with cerebral and left arm symptoms from the congenital subclavian steal syndrome is presented. Surgical correction was performed using an axillary-axillary bypass. Pre-operative noninvasive vascular evaluation demonstrated reversal of flow in the left carotid artery which was corrected postoperatively. There was complete relief of symptoms and equal upper extremity blood pressure. This report represents the first instance in which this extremely rare congenital disorder was fully evaluated with noninvasive vascular techniques, and the first to be treated with an extra-anatomical surgical approach.

Right aortic arch with contralateral congenital subclavian steal syndrome.

Three cases of right aortic arch associated with contralateral congenital subclavian steal syndrome are presented. Diagnosis may be made if special attention is given to the blood pressures and amplitude of pulses in both arms. Retrograde aortography is necessary to establish a definitive diagnosis. If symptoms are present in the adolescent, a bypass graft procedure should be performed.

Cerebral ischemia due to congenital malformations of brachiocephalic arteries--case reports.

Seven cases of congenital anomalies of brachiocephalic arteries are presented; malformations include unilateral absence of the internal carotid artery (ICA) (n = 3), unilateral hypoplasia of the ICA (n = 2), agenesis of the innominate artery (n = 1), and atresia of the subclavian artery (n = 1). All patients but 1 exhibited symptoms of cerebrovascular insufficiency at the time of radiologic investigation; they were not affected by other cardiovascular malformations, except right aortic arch in 2 cases and left cervical arch in another case. Two patients suffering from congenital subclavian steal syndrome underwent surgery to correct the vascular malformations. Embryogenesis and natural history of such malformations are briefly discussed.

Right aortic arch with atresia of aberrant left subclavian artery: case report.

We report a case of right aortic arch with atresia of the proximal portion of the aberrant left subclavian artery, a rare congenital vascular anomaly. Differential diagnosis from other conditions including right aortic arch with isolation of the left subclavian artery is discussed.

Congenital subclavian steal syndrome in an adult with a left aortic arch.

To our knowledge, all of the cases of congenital subclavian steal syndrome encountered to date in adults have involved a right aortic arch. We present an angiographically proven case of congenital subclavian steal syndrome involving a left aortic arch in an adult.

[Congenital subclavian steal syndrome. Apropos of 14 cases. Review of the literature]. / Le vol sous-clavier congénital. A propos de 14 observations. Revue de la littérature.

Fourteen cases of the congenital subclavian steal syndrome are presented with a review of 99 cases in the literature. This abnormality is usually asymptomatic and a fortuitous finding (clinical: asymmetric blood pressure; radiological: investigation of an associated cardiovascular malformation). The possible malformations are numerous and may be diagnosed by angiography: however, they can be suspected from three simple investigations, clinical examination indicating the side of lower blood pressure, chest X-ray and barium swallow. Seventy one per cent congenital subclavian steal syndromes are associated with a right-sided aortic arch, the steal being then almost always left-sided via a left subclavian artery anomaly. In this group, a left subclavian artery isolated from the aorta represents about a half of the cases. A cardiac malformation is present in one out of two cases and a patent ductus arteriosus uniting the left subclavian artery and the left pulmonary artery is observed in one out of four cases. Twenty nine per cent of congenital subclavian steal syndromes are associated with a left-sided aortic arch. In these cases the abnormalities usually involve the aortic arch (57% of cases) or a right or left subclavian artery. Therefore, in this group, there is no preferential side for the subclavian steal which can be right, left or bilateral. These abnormalities usually only require medical surveillance. When they become symptomatic, vertebro-subclavian revascularisation is justified. The presence of a subclavian steal may have surgical implications: it is important to exclude a subclavian steal before performing a Blalock anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Interruption of the aortic arch without patent ductus arteriosus. Apropos of a case associated with partial atrioventricular canal]. / Interruption de l'arche aortique sans canal artériel. A propos d'un cas associé à un canal atrio-ventriculaire partiel.

The authors report a case of type A interruption of the aortic arch with the subclavian arteries arising from the descending aorta which was of special interest because of the absence of a patent ductus arteriosus. Therefore, the systemic circulation was assured from the carotid arteries which perfused the vertebral arteries retrogradely via the circle of Willis. The association of a partial endocardial cushion defect and hypoplasia of the ventricle explained the surgical failure. A review of the literature of interruption of the aortic arch without a ductus confirmed that this was a rare condition and, paradoxically, well tolerated in the absence of associated malformations. On the other hand, the left ventricular lesions, usually present in the classical forms with patent ductus arteriosus, operated in the neonatal period, increase the operative risk.

[Subclavian steal syndrome from congenital atresia of the left subclavian artery (author's transl)]. / Le vol sous-clavier congénital par isolement de l'artere sous-clavière gauche.

Obstruction of the left subclavian artery is one of the rarest causes of the cogenital subclavian steal syndrome with a right-sided aorta. Radiological diagnosis can be made from a standard film which shows the aorta on the right, and a barium examination of the esophagus which demonstrates the absence of any compression posteriorly. Angiographic exploration (aortography, pulmonary angiography) is essential for positive confirmation of diagnosis and to exclude other types of congenital subclavian steal with a right-sided aorta. Certain cardiac malformations may be associated, but forms have been described without any other anomalies as in the case reported, which only became apparent when neurological symptoms developed in adult age.

[A case of congenital subclavian steal].

A case of congenital subclavian steal is reported. A 7-year-old girl was admitted on July 1980 to Shimane Medical University for evaluation of murmur over the region of the chest. Heart murmur was pointed out at the age of three month, however, she had no complaints and was growing normally. On admission, the blood pressure was 108/48 mmHg in the left arm and unobtainable in the right arm. The length of the arm was 53 cm on the right side and 55.4 cm on the left side. On auscultation, a systolic murmur was present over the chest and the right neck. The arch aortography disclosed the left aortic arch, the isolation of the right subclavian artery and the right patent ductus arteriosus (PDA). The left transfemoral vertebral angiography showed the retro-grade filling from the right vertebral artery to the right subclavian and pulmonary artery via the right PDA. The right external carotid angiography showed the filling of the right vertebral artery through muscular branches of the right occipital artery. The right retrograde brachial angiography showed small right subclavian artery and the filling of the pulmonary artery through the right PDA. The recorrective operation was made. Postoperatively, normal blood flow was recognized in angiography. The blood pressure improved in the right side and the murmur was diminished.

[Congenital subclavian steal syndrome: a case of right aortic arch with atretic aberrant left subclavian artery].

Surgical experience of a rare case of congenital subclavian steal syndrome is reported. A 53 year old man was admitted to our hospital complaining of black out attack and headache. Non invasive and angiographic studies revealed the subclavian steal associated with right aortic arch and atretic aberrant left subclavian artery. Through the supraclavicular incision, the direct anastomosis of the left common carotid and subclavian artery was performed. Postoperative angiograms showed a perfect reconstruction of the left subclavian artery and the disappearance of the subclavian steal and about on third amount of the complaints are still remained. Concerning a review of the literatures, several problems are discussed.