Description of cases
Case 1: 4-year-old male, with a history of respiratory tract infection and heart murmur, diagnosed a year before with patent ductus arteriosus and absence of RPA (Figure 1A ). Physical examination revealed a continuous murmur in the pulmonary site. The echocardiogram showed a wide ductus arteriosus, a dilated MPA continuing with left pulmonary artery (LPA) and absence of connection with the RPA.
Cardiac catheterization showed pulmonary hypertension and double ductus arteriosus with a discontinuous pulmonary artery, where the MPA continued with the LPA while the RPA was hypoplastic with an anomalous origin in a right filiform ductus arteriosus emerging from the brachiocephalic trunk. The left ductus arteriosus was closed with a ductal occluder device and a percutaneous transluminal angioplasty with placement of a right intraductal stent was performed (Figure 1B-C ).
At one year of follow-up, normal pulmonary pressure was verified with adequate development of RPA (Figure 2A-2B ), deciding upon a surgical correction with cardiopulmonary bypass without aortic cross clamping, with surgical closure of the right ductus arteriosus and connection of RPA to MPA with a Gore-Tex® 12 mm graft (Figure 2C ).
Case 2: 10-year-old female, with a history of fatigue, diaphoresis and continuous murmur in the pulmonary site. Echocardiography and computed tomography showed persistence of the ductus arteriosus and absence of RPA. Cardiac catheterization showed a double ductal system, hypoplastic RPA originating from the right ductus arteriosus emerging from the brachiocephalic trunk, a wide left ductus arteriosus and MPA continuing with LPA (Figure 3A ); additionally, an aortopulmonary collateral to the right lung and pulmonary hypertension was diagnosed. Percutaneous transluminal angioplasty was performed with placement of a right intraductal stent, transcatheter embolization of the aortopulmonary collateral with vascular plug and closure of the left ductus arteriosus with a ductal occluder device. One year later, she presented with proximal stenosis of the right ductus arteriosus for which a percutaneous transluminal balloon angioplasty was performed.
At 7 years of follow-up, she presented with normal pulmonary artery pressure and adequate development of RPA (Figure 3B ), performing a surgical repair with cardiopulmonary bypass without aortic cross clamping, connection of RPA to MPA with a Gore-Tex® 14 mm graft, in addition to the surgical closure of the right ductus arteriosus. Both patients presented a favorable postoperative outcome.