Hemoptysis following Mustard repair: a late complication

Hemoptysis was the presenting symptom in a 4-year, 11-month-old male who had had a Mustard operation for hemodynamic correction of transposition of the great vessels at the age of five months. Chest roentgenography demonstrated hyperlucency of the left lung and tomography showed compression and narrowing of left main stem bronchus. Angiography documented the absence of antegrade flow in the left pulmonary artery and no pulmonary venous drainage on the left. The left lung was supplied by bronchial collateral arteries which drained by retrograde filling of the left pulmonary artery. It is surmised that pulmonary venous drainage on the left was compromised at surgery and that the dilated main pulmonary artery compressed the left main stem bronchus. This combination promoted bronchial collateral ingrowth. Hemoptysis is a complication of enlargement of bronchial collateral vessels.