PMC6750180_01
Formation of left-sided aortic arch. RaoG - right dorsal aorta, LAoG - left dorsal aorta, LSA - left subclavian artery (the arrow indicates the direction of its migration), LCA - left carotid artery, III and IV - pharyngeal (aortic) arch arteries, DA - ductus arteriosus, AoS - aortic sac, PA - pulmonary trunk (author's own scheme - M.A.K)
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fig2
Fig. 4. Fig. 5, Fig. 6, Fig. 7 and Fig. 8). Figure 2, Fig. 3, Fig. 4 and Fig. 5 show a series of upper mediastinal vessel sections in a plane similar to transverse plane - horizontal.
A slightly higher cross-section, diastole. The ascending aorta (AoAsc) is not filled with color. Despite the diastolic phase, the pulmonary trunk (PA) and its two branches (RPA and LPA) are filled with intensive blue color - with distinct turbulence. A bulge corresponding to the outlet of the ductus arteriosus (*) is seen in the anterior contour of the pulmonary trunk (PA). The left common carotid artery is not visible during this phase. VBC - the brachiocephalic vein
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fig4
Fig. 4. Fig. 5, Fig. 6, Fig. 7 and Fig. 8). Figure 2, Fig. 3, Fig. 4 and Fig. 5 show a series of upper mediastinal vessel sections in a plane similar to transverse plane - horizontal.
A further shift of ultrasonic beam upwards, systole. Cross-sections of the ascending aorta (Ao) and the left common carotid artery (LCCA), which runs separately at the same level - both vessels are coded in red - as well as the ductus arteriosus (*) and the pulmonary trunk (PA) - these vessels are filled with blue color, indicative of a flow in the opposite direction
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fig5
Fig. 4. Fig. 5, Fig. 6, Fig. 7 and Fig. 8). Figure 2, Fig. 3, Fig. 4 and Fig. 5 show a series of upper mediastinal vessel sections in a plane similar to transverse plane - horizontal.
Even a higher position of the plane of the beam, systole. Cross-sections of the apical portion of the aortic arch (Ao) and the left common carotid artery (LCCA) filled with red color and the ductus arteriosus (*) filled with blue color. A very close proximity of these vessels is noticeable
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fig6
Figure 6, Fig. 7 and Fig. 8 show a series of upper mediastinal vessel sections in a plane similar to sagittal plane.
Systole. The ascending aorta (Ao) branching into the left common carotid artery (LCCA) is shown; both vessels are filled with red color and the initial segment of the aortic arch (AAo - blue color)
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fig7
Fig. 4. Fig. 5, Fig. 6, Fig. 7 and Fig. 8). Figure 2, Fig. 3, Fig. 4 and Fig. 5 show a series of upper mediastinal vessel sections in a plane similar to transverse plane - horizontal.
Systole. Further shift of the ultrasound beam to the left side - two close parallel vessels with opposite directions of flow: the left common carotid artery (LCCA) coded in red and the left subclavian artery with ductus arteriosus coded in blue (LSA + PDA)
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fig8
Figure 6, Fig. 7 and Fig. 8 show a series of upper mediastinal vessel sections in a plane similar to sagittal plane.
During diastole, the left subclavian artery/ductus arteriosus (PDA+LSA) are more intensely filled, whereas the red color coding for blood flow in the left common carotid artery disappears. Poorly filled with blue color brachiocephalic vein (BCV) is most superficially seen
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fig9
The diagnosis was extended by CT angiography (Fig. 9) - the presence of isolated left subclavian artery giving rise to a tortuous patent ductus arteriosus extending vertically (from the anterior aspect) to the pulmonary trunk was confirmed.
Postoperative assessment. Visible carotid segments of LCCA and LVA. Systole. The direction of the flow in the left vertebral artery is opposite to the flow in the left common carotid artery
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fig10
Postoperative ultrasonography still showed reversed flow in the left vertebral artery (LVA), representing the only supply of the left subclavian artery (LSA) (Fig. 10 and Fig. 11 show altered flow in the left common carotid artery and left vertebral artery after defect correction and ductus arteriosus closure).