This is a still-frame from a postoperative angiogram in another patient with contrast injected into the ascending aorta viewed in the anteroposterior projection. After the coronary arteries, the first branch of the aorta is the innominate artery, located here on the left. The aorta passes to the right side of the trachea and begins to descend along the right side of the spine. All of these features are characteristic of a right aortic arch, with otherwise normal branching in mirror image. The real-time study follows.
Left coronary artery system
This is still-frame from an angiogram with contrast injected into the left main coronary artery viewed in the left anterior oblique projection. Note the anatomy of the coronary arteries. It is important to identify that, as in this case, the left anterior descending coronary artery originates normally from the left main coronary artery. In 5-10% of patients with tetralogy of Fallot, either the entire left coronary artery or the left anterior descending coronary artery arises anomalously from the right coronary artery and courses across the right ventricular outflow tract, creating a potentially serious technical impediment to surgical repair. The real-time study follows.
Post Blalock-Taussig
This is still-frame from an angiogram that illustrates the aorta and its major branches in a patient who has undergone a right Blalock-Taussig shunt, named for Drs. Alfred Blalock, surgeon, and Helen Taussig, pediatric cardiologist, who initially described the operation at the Johns Hopkins University. The procedure connects the subclavian artery directly to the pulmonary artery, in this case, on the right side. This palliative operation bypasses the right ventricular outflow tract obstruction. It is utilized in patients who demonstrate a need for a secure supply of pulmonary blood flow and in whom total correction is not recommended. Usually, the subclavian artery arising from the innominate artery is used, as its counterpart on the other side tends to kink if it is employed.
Other surgical techniques exist for providing an arterial connection from the aorta to a pulmonary artery when the standard Blalock-Taussig procedure is not considered appropriate.
The real-time study follows.