Echocardiogram: Aortic Arch View (Suprasternal notch view)
Question 1: What is abnormal in Panel 1?
Answer: (i) Left innominate vein is not see at the angle between the ascending aora and the origin of first arch vessel. (ii) Cross section of a second vessel is noted posterior to ascending aorta in addition to the usual right pulmonary artery.
Question 2: What vascular anomaly should be looked for?
Answer: Retroaortic innominate vein.
This is a rare entity noted in patient with Tetralogy of Fallot with Right aortic arch or when aorta has a "high" arch.
Clinical significance stems from rare clinical tales of the surgeon mistaking this retroaortic innominate vein for right pulmonary artery and places the BT shunt from subclavian artery to the innominate vein (& not to the right pulmonary artery).
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