Figure Legends
Figures 1A-1F : Axial computed-tomographic angiography images (A to C,
cranial to caudal) shows the left brachiocephalic vein (L) crossing
posterior to the aorta (A) and joining the right brachiocephalic vein
(R) to form the right-sided superior vena cava (RSVC). Volume rendered
images (D, anterior view; E, anterior view with aorta digitally
subtracted and F, posterior view with aorta digitally subtracted)
demonstrates the retroaortic course of the left brachiocephalic vein.
Figures 2A, 2B : Transthoracic Echocardiogram images with color Doppler
interrogation demonstrating the retro-aortic innominate vein. Panel A
shows parasternal short axis view at the level of ascending aorta (AO).
The brachiocephalic vein (IV) is seen coursing posterior to the
ascending aorta and anterior to right pulmonary artery. Panel B shows
the suprasternal view in which the brachiocephalic vein (IV) is seen
coursing below the arch of aorta. The right pulmonary artery (RPA) is
visualized coursing posterior and inferior to the retro-aortic
brachiocephalic vein.
Figures 3A-3C : Four chamber image (A) and oblique sagittal image (B)
shows presence of subaortic ventricular septal defect (*) with aortic
(A) override in a patient of tetralogy of Fallot. Right ventricular (RV)
hypertrophy is also noted. Oblique coronal image (C) shows presence of
severe infundibular stenosis (arrowhead).
Figures 4A-4C : Volume rendered images (A to C) show presence of
subaortic ventricular septal defect (*) with aortic (A) override. Right
ventricular (RV) hypertrophy is noted with severe infundibular stenosis
(arrowhead).
Figure 5A-5H : Diagram illustrating the normal and abnormal course of
left brachiocephalic vein
A: Normal course of left brachiocephalic vein in front of the great
arteries.
B: The anomalous left brachiocephalic vein crosses the midline above the
aortic arch posterior to the origin of the great arteries.
C: The anomalous brachiocephalic vein passes beneath the aortic arch
over the pulmonary artery bifurcation in front of the arterial duct.
D: The anomalous brachiocephalic vein passes posterior to the arterial
duct, beneath the aortic arch and above the pulmonary artery.
E: The anomalous brachiocephalic vein crosses behind the main pulmonary
trunk away from the arterial duct.
F: The anomalous brachiocephalic vein passes posterior to trachea and
esophagus and joins the azygous vein.
G: The anomalous brachiocephalic vein divides into two branches. The
anterior branch is located above aortic arch, behind the brachiocephalic
trunk. The posterior branch crosses posterior to esophagus and joins the
azygous vein before draining to right superior caval vein.
H: The circumaortic anomalous brachiocephalic vein divides into two
branches. The anterior branch courses above aortic arch anterior to
great arteries. The posterior branch courses below the aortic arch and
posterior to descending thoracic aorta. Both branches joined the right
superior caval vein separately.
Figure 6 : Diagrammatic representation of use of retroaortic left
brachiocephalic vein in pulmonary artery reconstruction by creating a
wide side-to-side anastomosis. The child had tricuspid atresia,
pulmonary atresia with a left modified Blalock-Taussig shunt, a stented
arterial duct and blocked central aortopulmonary shunt to the right
pulmonary artery.
Abbreviations: ACV: Anterior cardinal vein, AO: Ascending
aorta, APS: Aortopulmonary shunt, AV: Azygous vein, BCA: Brachiocephalic
artery, CCV: Common cardinal vein, DTA: Descending thoracic aorta, ITCP:
Inferior transverse capillary plexus, IV: Brachiocephalic vein, LBCV:
Left brachiocephalic vein, LCCA: Left common carotid artery, LIJV: Left
internal jugular vein, LOM: Ligament of Marshall, LPA: Left pulmonary
artery, LSA: Left subclavian artery, LSV: Left subclavian vein, LV: Left
ventricle, P: Pulmonary trunk, PA: Pulmonary artery, PAD: Patent
arterial duct, PCV: Posterior cardinal vein, RA: Right atrium, RPA:
Right pulmonary artery, RSVC: Right-sided superior vena cava, RVCV:
Right brachiocephalic vein, STCP: Superior transverse capillary plexus,
SV: Sinus venosus, SVC: Superior caval vein, VOM: Vein of Marshall,