case_images: PMC11794723_01
case_images: A 2D image of parasternal long axis view showing the RPA arising from the ascending aorta (white asterisk). B Color Doppler of parasternal long axis view showing the RPA (white asterisk). C: Suprasternal long axis view showing RPA (white asterisk) and the retrograde flow in the aortic arch (yellow arrow). D The parasternal short-axis view shows the right-to-left PDA flow (yellow arrow). E An apical four-chamber view shows moderate tricuspid regurgitation (TR) with dilated RA and RV F Continuous wave Doppler at TR showing a TR gradient of 70 mmHg (indicating severe pulmonary hypertension). G Suprasternal long axis view showing the aortic arch and the proximal descending aorta with no coarctation. Ao: aorta: LA: left atrium, LPA: left pulmonary artery, LV: left ventricle, MPA: mean pulmonary artery, PDA: patent ductus arteriosus, RA: right atrium, RPA: right pulmonary artery, RV: right ventricle, TR: tricuspid regurgitation
case_images: 43044_2025_614_Fig1_HTML.jpg
case_images: PMC11794723_01_43044_2025_614_Fig1_HTML.jpg
case_images: Fig1
case_images: The RPA anomalously arose from the ascending aorta (Fig. 1A-G, video 1).
case_images: A MDCT angiography with 3D reconstruction and right lateral projection showing the anomalous RPA from the ascending aorta (white arrow). B MDCT angiography with 3D reconstruction and posterior projection showing the aberrant right subclavian artery (white arrow) with no coarctation of the aorta. C MDCT angiography with 3D reconstruction and left lateral projection showing the large PDA (white arrow) connected to the descending aorta. D The parasternal short-axis view shows constriction of the PDA with right-to-left shunting after the discontinuation of prostaglandins (yellow arrow). E Preoperative chest x-ray showing plethoric right lung. F The parasternal short-axis view shows postoperative RPA stenosis (yellow arrow). G continuous wave Doppler showing postoperative RPA stenosis with diastolic runoff (yellow arrows). MDCT: multidetector computed tomography, MPA: mean pulmonary artery, PDA: patent ductus arteriosus, RPA: right pulmonary artery
case_images: 43044_2025_614_Fig2_HTML.jpg
case_images: PMC11794723_01_43044_2025_614_Fig2_HTML.jpg
case_images: Fig2
case_images: Multidetector computed tomography (MDCT) revealed an anomalous origin of RPA (5.5 mm) from the proximal ascending aorta, large PDA (7.5 mm) with a focal narrowing at the pulmonary arterial connection to a diameter of 5 x 3.5 mm, and left-sided aortic arch with an aberrant right subclavian artery with no focal aortic coarctation (Fig. 2A-C). The patient was intubated, and an echocardiogram was performed immediately after deterioration, which revealed a closing ductus arteriosus along with a significantly reduced blood flow in the descending aorta and a dilated right ventricle (RV) with poor systolic function (Fig. 2D, video 2), and small PFO with right-to-left shunt. Echocardiography was done in the clinic that revealed severe RPA stenosis, and the patient was booked for cardiac catheterization for balloon angioplasty (Fig. 2F-G, video 3).