Anomalous origin of the left pulmonary artery from the ascending aorta is a rare cardiac malformation more commonly described with tetralogy of Fallot (TOF). The association of absent right carotid artery with TOF and anomalous left pulmonary artery from the ascending aorta has been rarely reported in the past. This case highlights the need for careful evaluation of the aortic arch and head vessels anatomy in patients with TOF because of the potential neurologic complications after surgery.
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