Anomalous origin of the left common carotid artery from the pulmonary artery associated to Holt Oram syndrome: a case report

Multiple malformations of the aortic arch have been described, however the anomalous origin of the left carotid artery from the pulmonary artery is an extremely rare malformation and even more so its association with intracardiac abnormality, there are only eight cases described in the literature. Possible causes are alterations in the habitual regression of the aortic arches or their abnormal persistence. Likewise, its association with Holt Oram syndrome has not been reported to the best of the authors' knowledge. A one-year-old female patient with Holt Oram syndrome, gastroesophageal and vesicoureteral reflux; with an anomalous origin of the internal common carotid artery from the trunk of the pulmonary artery confirmed by Angio Tomography. It was corrected under extracorporeal circulation with ligation of the anomaly prior to the start of cardiopulmonary bypass and the septal defects were closed with a bovine pericardial patch, pulmonary stenosis was relieved. It evolved favorably and remains asymptomatic after two years of follow-up. Surgical techniques include reimplantation of the artery to the arotic arch or ligation of the abnormal vessel. The main side effects of reimplantation include cerebral reperfusion edema and prolongation of extracorporeal circulation time. The ligation of the abnormal case can be considered safe and effective in avoiding the pathophysiological consequences of this disease. (C) 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.