Capabilities of Computed Tomographic Angiography: A Case of Anomalous Origin of the Right Subclavian and Left Pulmonary Arteries in an Infant With Tetralogy of Fallot

Objective : To demonstrate capabilities of multislice computed tomography (CT) in detailing a congenital heart disease (CHD), tetralogy of Fallot (TOF), in an infant. Case report : We report a case of suspected TOF in a 3-month-old patient who underwent transthoracic echocardiography (TTE) at an initial hospitalization site and was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) for further examination and treatment planning. The examination was supplemented with CT and computed tomographic angiography (CTA). Results : TTE diagnosed TOF, patent ductus arteriosus, functional foramen ovale, right-sided aortic arch, and major aortopulmonary collateral arteries. CT and CTA revealed biventricular origin of the aorta, infundibular pulmonary stenosis, right ventricular outflow tract stenosis, and abnormal origin of the left pulmonary artery and the right subclavian artery. Discussion : TTE is the primary screening method for TOF; however, its data are insufficient for planning surgical treatment. As a clarifying method, CTA is needed to detail the CHD, objectively assess the aorta, pulmonary veins and arteries, and exclude an extracardiac pathology. Conclusions : The success of CHD surgical correction in children lies in the preoperative assessment of all anatomical features that determine the sequence of treatment and potential surgical risks. Using a single imaging method is insufficient to obtain reliable and accurate results when choosing a surgical strategy for patients with complex CHDs. Chest CTA has proven to be a highly effective method in assessing the CHD and clinically significant anatomical features.