A 2-week-old male with antenatal diagnosis of ‘pink’ Tetralogy of Fallot was referred to our unit. The transthoracic echocardiography showed a large malalignment ventricular septal defect with overriding aorta, and mild pulmonary valve stenosis in absence of significant sub-valvar right ventricle outflow tract obstruction. A right aortic arch with a non-bifurcating first branch was demonstrated. On the high parasternal short axis view, a vessel originating from the main pulmonary trunk was detected, going leftward and then superiorly. The flow direction within the anomalous structure was towards the pulmonary circulation, representing an additional pulmonary blood flow supply (A; Supplementary data online, Video S1). This was suspected to be the left duct connected to the left subclavian artery (red arrow). A cardiac computed tomography was performed (B...

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