Development of rib notching after a cava-pulmonary anastomosis

A patient with tetralogy of Fallot and mitral regurgitation developed unilateral rib notching on the right side secondary to a palliative cava-pulmonary anastomosis. After the operation, decreased perfusion of the right upper and middle lobes stimulated the development of collateral vessels from the systemic circulation to the right pulmonary artery. To our knowledge, this is the first time that this has been described.