Right aortic arch with cervical origin of left subclavian artery: Unusual arch anomaly associated with tetralogy of Fallot

A 2-year-old girl with Tetralogy of Fallot and pulmonary atresia with a prior history of central shunt surgery was found to have an abnormal pulsation on the left side of her neck. Evaluation by computed tomography and invasive catheterization study revealed an unusual arch anomaly. There was a right aortic arch with a high-riding brachiocephalic artery and a cervical origin of the left subclavian artery, forming double hairpin loops in combination with a dilated left vertebral artery, previously unreported in the literature. Recognition of arch vessel anomalies in children with congenital heart disease is critical for procedural planning and preventing inadvertent vascular injury.