Pulmonary perfusion defect and bronchial artery collateral blood flow

A five-year-old child with severe congestive heart failure following repair of tetralogy of Fallot was examined for correction of a suspected left-to-right shunt. Lung scan and selective bronchial angiographs demonstrated greatly diminished perfusion to the right upper lobe, which was supplied by a large bronchial artery. Technetium microspheres were injected into the artery for quantification. Subsequently, the artery was occluded by injection of the tissue-adhesive bucrylate. During the following year, radionuclide scans showed improvement in the uniformity and percentage distribution of pulmonary perfusion by way of the pulmonary artery. The child has become asymptomatic following closure of the bronchial vessel.