Aortic atresia with complex aortic arch collateralization through the subclavian arteries.

A term newborn boy was diagnosed with aortic atresia and ventricular septal defect with duplicated subclavian arteries bilaterally. Computed tomography angiography demonstrated highly unusual aortic arch vasculature. A diminutive aortic arch and complex head vessel anatomy precluded standard surgical palliation with a Damus-Kaye-Stansel, arch reconstruction, and systemic to pulmonary artery shunt. Instead, the patient underwent placement of bilateral pulmonary artery bands and stenting of the patent arterial duct (PDA). At 2 months of age, the patient underwent PDA stent dilation. At 4 months of age, he underwent balloon angioplasty of pulmonary artery bands with transverse aortic stenting. At the most recent follow-up at 15 months of age, there was no significant growth of the aortic arch, and the patient was mildly hypertensive but otherwise hemodynamically stable. He is currently being evaluated for heart transplantation due to his complex vascular anatomy.