Right Aortic Arch With Bilateral Ductus Arteriosus, Aberrant Left Subclavian Artery, Interrupted Left Carotid Artery

We show an exceptional case of a right aortic arch (RAA) in a patient with DiGeorge syndrome, breaking the rule that the first epiaortic vessel courses to the contralateral side of the aortic arch. This is a RAA with an aberrant left subclavian artery (ALSA) and an isolated left carotid artery (ILCA) arising from the left pulmonary artery (LPA) via a left anterior ductus arteriosus (LADA), along with bilateral ductus arteriosus. This unique case highlights educational pitfalls in using a simple rule to define arch sidedness. Although challenging, echocardiographic diagnosis of such vascular anomalies is feasible in expert hands. The color-flow and Doppler pattern of the epiaortic vessels provide important information about their arrangement and connection to the aortic arch. Bilateral ductus arteriosus is often a marker of complex vascular anomalies, which are frequently associated with genetic syndromes.