Pulmonary infarction following ligation of terminally shunted pulmonary artery

The intracardiac repair of tetralogy of Fallot occasionally is complicated by the presence of a surgically created shunt between a systemic artery and the distal end of a divided pulmonary artery. Rarely, reconstruction of this pulmonary artery at the time of corrective operation is not technically feasible. Usually, this problem has been managed by obliterating the systemic-to-pulmonary arterial shunt, which has not previously been reported to result in complications in the involved lung. Two of our patients underwent intracardiac repair of tetralogy of Fallot, including ligation of a terminally shunted left pulmonary artery. Postoperatively they developed infarction of the left lung with resulting acute respiratory insufficiency. In both instances, conservative management ultimately achieved resolution of the pathological process and a good clinical result.