Luetmer P H, Miller G M
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1990 Mar;65(3):407-13. doi: 10.1016/s0025-6196(12)62540-3.
Of the right aortic arch anomalies, a right arch with isolation of the left subclavian artery is the least common. Herein we describe a 52-year-old woman in whom this anomaly was discovered during cerebral angiography for evaluation of a giant symptomatic intracavernous carotid aneurysm. Isolation of the left subclavian artery may be suggested in a patient with a right arch in whom the blood pressure or pulse in the left upper extremity is diminished. Although the isolated left subclavian artery produces the hemodynamic alterations of a subclavian steal, review of the 39 cases reported in the literature revealed only 5 patients with symptoms suggestive of vertebrobasilar insufficiency and 5 patients with weakness of the left upper extremity. Although the patient we describe had no known heart disease, congenital heart disease was present in 23 of the 39 reported cases (59%), tetralogy of Fallot occurring most frequently.
在右主动脉弓异常中，右弓伴左锁骨下动脉孤立是最不常见的。在此，我们描述一名52岁女性，其在因评估巨大有症状的海绵窦内颈动脉动脉瘤而进行脑血管造影时发现了这种异常。对于右弓且左上肢血压或脉搏减弱的患者，可能提示存在左锁骨下动脉孤立。尽管孤立的左锁骨下动脉会产生锁骨下动脉盗血的血流动力学改变，但回顾文献报道的39例病例发现，仅有5例患者有提示椎基底动脉供血不足的症状，5例患者有左上肢无力症状。尽管我们描述的患者没有已知的心脏病，但在报道的39例病例中有23例（59%）存在先天性心脏病，其中法洛四联症最为常见。
