Guest Post II – RIGHT AORTIC ARCH WITH LEFT DUCTUS ARTERIOSUS (U – sign)

We present a case of isolated right aortic arch with left ductus arteriosus picked during anomaly scan at 19wks 6days in a 22 year old primigravida.During cardiac evaluation, the four chamber view grossly appeared unremarkable with normal origin and cross-over of great vessels. However, in three-vessel-trachea view, there appeared to be increased distance between Pulmonary artery (PA) and Aorta (Ao). The course of the Ao was to the right side of the trachea and the PA and ductus arteriosus to the left. On CD, the vessels demonstrated a ‘U’ configuration connecting behind the trachea.

Dr Sumedha Arora and Dr Tejinder PS Bajwa – Nijjar Scanning Centre, Amritsar, Punjab

We present a case of isolated right aortic arch with left ductus arteriosus picked during anomaly scan at 19wks 6days in a 22 year old primigravida.During cardiac evaluation, the four chamber view grossly appeared unremarkable with normal origin and cross-over of great vessels. However, in three-vessel-trachea view, there appeared to be increased distance between Pulmonary artery (PA) and Aorta (Ao). The course of the Ao was to the right side of the trachea and the PA and ductus arteriosus to the left. On CD, the vessels demonstrated a ‘U’ configuration connecting behind the trachea. On reviewing four chamber view the desc aorta was seen located more centrally anterior to the spine. Thymus appeared normal. No other extracardiac anomaly was seen.Right Aortic Arch with left DA is commonly an isolated finding in the majority of cases with  rare associated cardiac and extracardiac malformations like conotruncal anomalies and microdeletion 22q11.This case demonstrates the importance of three-vessel-trachea view. In all cases with right aortic arch, Double aortic arch should be ruled out which forms a tight vascular ring around trachea and esophagus needing surgical intervention post-natally.