Anomalous Left Innominate Artery off the Pulmonary Artery in Patient With Tetralogy of Fallot

Video Supplement to "An Unusual Congenital Aorto-pulmonary Shunt in Tetralogy of Fallot: Anomalous Left Innominate Artery off the Pulmonary Artery" by Duffy, et al (June 2023 Clinical Images).

A 3-year-old female presented to our hospital with CHARGE association, tracheoesophageal fistula, neonatal hemorrhagic stroke, and tetralogy of Fallot with a right aortic arch and an anomalous origin of the left innominate artery arising from the pulmonary artery. Aortic angiography showed a right aortic arch with only right carotid and right subclavian arteries and retrograde filling of the left carotid, left subclavian artery, and pulmonary arteries. Angiography of the left subclavian artery showed the tortuous, stenotic arterial connection between the pulmonary arteries and left subclavian artery. After stent placement, there was marked improvement in the caliber of the vessel and systemic saturations.