Introduction
Anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery (RPA) is extremely rare in dextro-transposition of the great arteries (d-TGA). Only a few cases have been reported.1-6 Diagnosis is usually incidentally made using Computed Tomography (CT) or invasive angiography. We report a patient that was interestingly suspected based on clinical presentation and subsequently diagnosed with transthoracic echocardiography (TTE). This case demonstrates the importance of considering aortic arch anomalies in d-TGA when patients do not show reverse differential cyanosis. We also discuss the clinical significance, embryology, approach to echocardiographic diagnosis, and surgical implications.