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Catheter interventions for “double steal” from isolation of the subclavian artery associated with patent arterial duct

Published online by Cambridge University Press:  06 March 2013

Nageswara R. Koneti ,
Shakeel A. Qureshi  and
Kothandam Sivakumar
Nageswara R. Koneti
Affiliation:
Department of Pediatric Cardiology, Care Hospital, Hyderabad, India
Shakeel A. Qureshi
Affiliation:
Department of Pediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
Kothandam Sivakumar*
Affiliation:
Department of Pediatric Cardiology, MIOT Hospital, Chennai, India
*
Correspondence to: Dr K. Sivakumar, MD DM, Senior Consultant Cardiologist, Department of Pediatric Cardiology, MIOT Hospital, 4/112, Mount Poonamalle Road, Chennai 600089, India. Tel: +91 44 22492643; Fax: +91 44 22491188; E-mail: drkumarsiva@hotmail.com
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Abstract

Isolation of the subclavian artery is associated with “steal” of blood from the carotid circulation to the arm, through the circle of Willis and the vertebral artery. When associated with a patent arterial duct, there is an additional “steal” of blood from the arm to the lungs, through the arterial duct because of the lower pulmonary vascular resistance. When this combination manifests clinically with arm ischaemia on the side of the isolated subclavian artery, closure of the arterial duct will prevent the “steal” of blood from the subclavian artery to the pulmonary artery and may improve the blood flow to the arm. We report three patients with this unusual combination of the “steal” phenomenon that improved after interventional closure of the arterial duct. This report discusses the embryological basis of the defect, clinical and echocardiographic clues to diagnose this unusual anomaly, angiographic findings, and transcatheter management options.

Keywords

Subclavian arteryisolationpatent arterial ductcatheter interventionssubclavian stealaortic arch anomaly
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 95 - 98
Copyright
Copyright © Cambridge University Press 2013 

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