A common arterial trunk with pulmonary dominance is rare. We report the use of 3D volume-rendered CT imaging to define common arterial trunk with pulmonary arterial dominance and associated abnormalities.

We report a case of a 27-day-old girl with an unusual association of crossed pulmonary arteries with common arterial trunk showing pulmonary dominance with an interruption of aortic arch between the origin of the left common carotid artery and left subclavian artery. This case highlights the potential airway-related implications of this variant pulmonary arterial anatomy in the setting of the common arterial trunk and the role of computed tomography angiography in providing not only accurate and three-dimensional visualization of complex cardiovascular anatomy, but also a comprehensive evaluation of associated airway abnormalities with great precision.

The pulmonary dominant variant of the common arterial trunk has always been reported to be associated with aortic coarctation, or interruption of the aortic arch, along with a duct-dependent systemic circulation. This mandates a complex surgical repair with attendant high surgical mortality. We report a 23-day-old baby with a pulmonary dominant trunk with mild aortic hypoplasia but with an arch free of coarctation or interruption, who underwent successful surgical repair. In the preoperative evaluation of a common arterial trunk, pulmonary dominance may not necessarily denote an adverse risk factor when the aorta is only mildly hypoplastic.

The arrangement of aortic and pulmonary pathways is extremely variable in the hearts with a common arterial trunk. Almost always, interruption of the aortic arch is seen in the setting of hypoplasia of the ascending aorta and dominance of the pulmonary circulation. This subset poses substantial challenges in surgical repair and portends poor outcomes. In this report, we briefly describe the technique of ascending aorta reconstruction and other aspects of the surgical repair of this rare malformation.