Congenital Aortic Arch Abnormality in Tetralogy of Fallot: A Rare Case Report

Congenital Aortic Arch Abnormality in Tetralogy of Fallot: A Rare Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Congenital Aortic Arch Abnormality in Tetralogy of Fallot: A Rare Case Report Dr. Rakshand Shetty, Dr Madhu C S, Dr Akash Uppin, Dr. Rupali Sachdev This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4724669/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A 4-year-old male child was referred to the paediatrics department of our hospital from an Anganwadi with complaints of easy fatiguability compared to peers, dyspnea on normal exertion and refusal to feed for 10 days. There was no history of palpitation, bluish discolouration, pedal edema, abdominal distention, cough, or orthopnoea. On auscultation, a grade 2 end systolic murmur was heard. Full blood count revealed a Hb 10 g/dl, MCV 67.2 fL, MCH 20.9, and HCT 32.1%. Liver and kidney function tests were within normal limits. However, the Total T3 (2.85 nmol/L) and TSH were elevated (9.30 mmol/L). Chest X-ray indicated cardiomegaly with right ventricular enlargement with clear lung fields and pleural spaces. ECG further showed right axis deviation and enlargement of the right ventricle. He was diagnosed with Tetralogy of Fallot on 2D Echo, having confluent good-sized pulmonary arteries (Macgoon’s ratio: 1:4), large malaligned VSD with BD shunt, severe valvular and sub-pulmonary annular stenosis. These findings were further confirmed on MDCT Chest with Pulmonary Angiography. Furthermore, Bilateral anomalous origin of both right and left vertebral arteries from the arch of aorta was also observed. Later the patient was scheduled for elective surgical repair. Sauvage patch closure of VSD was done with 5-O continuous prolene sutures followed by reconstruction of the RVOT by augmenting it with a pericardial patch. The postoperative course was uneventful with minimal drainage. The patient was discharged on Injection Ceftumand Injection Lefoflox with infective endocarditis prophylaxis. In this case, we aimed to discuss the diagnostic implications of variations in the aortic arch with a special focus on the imaging and approach to the management. Vertebral arteries anomalies Implications and Diagnosis Arch of aorta anomalies Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4724669","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":325718165,"identity":"59e2b0e2-475b-42e9-8a31-b8dd86a8e525","order_by":0,"name":"Dr. Rakshand Shetty","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYFACNgZmIMnYIAHm2YDYjQeI1cLYcIAhDcwmScthsBheLebtx5I/F9TckZ0/u/n4449t5+3Wth8Gaq2xicalReZM2jHpGceeGW+4cyyx4WDb7eRtZxKBWo6l5Tbg0CLBkN7GzMN2OHGDRI4hWIvZAaAWxobDuLXwP2/+zPPvcOL8GfkfgVrOJZudf0hAi0TaAWnetsOJDTdyGIFaDtiZ3SBki8SzNGnevsPGG26kGc44cy45wewG0JYEfH7hTzP+zPPtsOz8GckPPlSU2dmbnU9/+OBDjQ1OLaiAkY0hEawygSjlYPCHwZ54xaNgFIyCUTBSAAC25W3MhbVsHAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-2228-2857","institution":"SDM College of Medical Sciences and Hospital","correspondingAuthor":true,"prefix":"Dr.","firstName":"Rakshand","middleName":"","lastName":"Shetty","suffix":""},{"id":325718166,"identity":"9697f929-c409-4d58-a88e-e8fa74780396","order_by":1,"name":"Dr Madhu C S","email":"","orcid":"https://orcid.org/0000-0001-8053-7809","institution":"SDM College of Medical Sciences and Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Madhu","middleName":"C","lastName":"S","suffix":""},{"id":325718881,"identity":"81c74c39-961e-4565-b2d2-bfe6342bc14a","order_by":2,"name":"Dr Akash Uppin","email":"","orcid":"","institution":"SDM College of Medical Sciences and Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Akash","middleName":"","lastName":"Uppin","suffix":""},{"id":325718882,"identity":"c0b6d588-8ca2-4044-9e76-ace4ece88289","order_by":3,"name":"Dr. Rupali Sachdev","email":"","orcid":"","institution":"Royal Liverpool University Hospital, Liverpool, United Kingdom","correspondingAuthor":false,"prefix":"Dr.","firstName":"Rupali","middleName":"","lastName":"Sachdev","suffix":""}],"badges":[],"createdAt":"2024-07-11 14:08:15","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4724669/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4724669/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60270251,"identity":"d50d5d24-1ba7-4c67-857c-eb373274ebe5","added_by":"auto","created_at":"2024-07-15 03:14:08","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":373785,"visible":true,"origin":"","legend":"","description":"","filename":"TOFCaseSubmitPdf.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4724669/v1_covered_93f29b92-1f55-4df5-a7d3-b7d064bea261.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCongenital Aortic Arch Abnormality in Tetralogy of Fallot: A Rare Case Report\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"SDM College of Medical Science and Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vertebral arteries anomalies, Implications and Diagnosis, Arch of aorta anomalies","lastPublishedDoi":"10.21203/rs.3.rs-4724669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4724669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 4-year-old male child was referred to the paediatrics department of our hospital from an Anganwadi with complaints of easy fatiguability compared to peers, dyspnea on normal exertion and refusal to feed for 10 days. There was no history of palpitation, bluish discolouration, pedal edema, abdominal distention, cough, or orthopnoea. On auscultation, a grade 2 end systolic murmur was heard. Full blood count revealed a Hb 10 g/dl, MCV 67.2 fL, MCH 20.9, and HCT 32.1%. Liver and kidney function tests were within normal limits. However, the Total T3 (2.85 nmol/L) and TSH were elevated (9.30 mmol/L).\u003c/p\u003e\n\u003cp\u003eChest X-ray indicated cardiomegaly with right ventricular enlargement with clear lung fields and pleural spaces. ECG further showed right axis deviation and enlargement of the right ventricle. He was diagnosed with Tetralogy of Fallot on 2D Echo, having confluent good-sized pulmonary arteries (Macgoon’s ratio: 1:4), large malaligned VSD with BD shunt, severe valvular and sub-pulmonary annular stenosis. These findings were further confirmed on MDCT Chest with Pulmonary Angiography. 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