Presentation
Dysphagia
Patient Data
The right ventricle is dilated and hypertrophied. The aorta overrides the right and left ventricles with a subaortic ventricular septal defect (VSD). There is a hypoplasia of the pulmonary artery. The right subclavian artery aberrantly originates from the distal aortic arch and courses posterior to the esophagus, compressing and narrowing its lumen. The left vertebral artery has a direct origin from the aortic arch.
The aortic arch gives the following branches in order from proximal to distal:
The aorta overrides the right and left ventricles in a ratio of 50:50. The right ventricular outflow tract (RVOT) shows hypertrophied infundibular muscle. The right ventricle is hypertrophied and appears of similar muscle thickness to the left.
The trachea is patent with no significant narrowing. The esophagus is markedly attenuated by the aberrant passage of the right subclavian artery posterior to it.
Case Discussion
Tetralogy of Fallot is the most common complex cyanotic congenital heart disease. It is usually associated with anomalies of the aortic arch. The aberrant origin of the right subclavian artery from the distal left-sided aortic arch is one of the types of pediatric vascular rings. The abnormal course of the vessel posterior to the esophagus may cause dysphagia lusoria, stridor or both.
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