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case_images: Duplex echoencephalography using transcranial power Doppler through the anterior fontanelle (green) and left temporal window (red). Blood supply to the entire brain depends on the internal carotid arteries (ICAs). There is anteroposterior flow in the posterior communicating arteries. Flow is maintained in the P2 segment of the posterior cerebral arteries (PCAs). Flow reversal is seen in the P1 segment of the PCAs and the basilar artery.
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case_images: In the axial plane through the temporal window (Figure 1), the flow was anteroposterior in both posterior communicating arteries (PCOMs).
case_images: Duplex power Doppler echoencephalography (a) through the anterior fontanelle showed reverse flow in the basilar artery (BA). Color Doppler echoencephalography (b), with blue indicating flow away from the transducer, showed that reverse flow in the BAs was accompanied by reversed flow in the left vertebral artery (VA) while flow remained anterograde in the right VA. Diagnosis of interrupted aortic arch is suspected.
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case_images: In the coronal plane through the anterior fontanelle, Duplex power Doppler echoencephalography (Figure 2(a)) showed retrograde flow in the BA. In the same plane, color Doppler echoencephalography (Figure 2(b) with blue indicating flow away from the transducer) showed retrograde flow in the BA and left VA.
case_images: Suprasternal echocardiogram in normal control ((a) and (b)). The ascending aorta branches into the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery before becoming the descending aorta. Suprasternal echocardiogram in the patient with type B interrupted aortic arch (IAA) ((c) and (d)). The hypoplastic ascending aorta becomes a single innominate artery (bovine aortic arch) that terminates in a brachiocephalic artery and a left carotid artery. The white arrow indicates where the aortic arch is interrupted. Below the IAA, the patent ductus arteriosus provides deoxygenated blood to the lower extremities.
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case_images: The echocardiogram showed a large perimembranous ventricular septal defect (VSD) with bidirectional shunting (not shown), a hypoplastic and bicuspid aortic valve (not shown), a 5 mm patent ductus arteriosus (PDA) with predominant right to left shunting, and an aortic arch interrupted between the left common carotid artery and the left subclavian artery (type B IAA) (Figure 3).
case_images: Duplex power Doppler echoencephalography through the anterior fontanelle showing anterograde flow in the basilar artery after surgical correction of the interrupted aortic arch.
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case_images: Repeated echoencephalography demonstrated the normalization of flow direction in the BA (Figure 4).