title: Inadvertent ligation of the left pulmonary artery during intended ductal ligation.
abstract: BACKGROUND
  Inadvertent ligation of the left pulmonary artery during attempted surgical closure of a Patent Ductus Arteriosus has long been recognized as one of the less common complications of this procedure. Surgical reconstruction of the left pulmonary artery was then often attempted but was difficult or impossible in some of the patients with hypoplasia of the left pulmonary artery and the left lung.
  
  
  METHODS
  A 10-year-old girl presented with marked exercise intolerance and palpitations and was diagnosed to have large PDA. She had feeding difficulty, diaphoresis, failure to gain weight, recurrent chest infections during infancy and early childhood. Physical examination revealed an underweight child with wide pulse pressure and bounding peripheral pulses. She had active precordium with accentuated P2 and machinery murmur in the left 2nd intercostal space and mid diastolic rumble at the mitral area. Echocardiography showed a 12 mm patent arterial duct. She was taken for an intended surgical ligation of the duct but a control echocardiogram on the 3rd postoperative day revealed that the left pulmonary artery, instead of the duct, was ligated. Surgical reconstruction of the left pulmonary artery was undertaken 3 years later, however, this was complicated by post reconstruction left pulmonary artery stenosis. Successful percutaneous stenting of the left pulmonary artery was performed 18 months after the surgical reconstruction.
  
  
  CONCLUSIONS
  The incidence of inadvertent LPA ligation may be underestimated where PDA ligation is done by less experienced surgeons and postoperative echocardiography is not routinely performed. Late correction of inadvertent LPA ligation is an important surgical challenge, especially if the duct is still patent. Percutaneous stenting as a primary option may carry significant risk, as the ligated pulmonary artery is fragile. In our case, a good result was achieved with surgical repair followed by percutaneous stenting.
authors.affiliation: Cardiology Unit, Department of Pediatrics and Child Heath, School of Medicine, Addis Ababa University, Corner of Zambia and T. Abanefso road, P.O.Box 1768, Addis Ababa, Ethiopia. endalet2008@gmail.com.
authors.forename: Endale
authors.initials: E
authors.lastname: Tefera
authors.affiliation: Department of Pediatric Cardiology, Ramon y Cajal University Hospital, Madrid, Spain. rbermudezcardio@gmail.com.
authors.forename: Ramon
authors.initials: R
authors.lastname: Bermudez-Cañete
authors.affiliation: Congenital Cardiac Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK. cavdoorn@yahoo.co.uk.
authors.forename: Carin
authors.initials: C
authors.lastname: van Doorn
mesh_terms: D002648:Child; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004374:Ductus Arteriosus, Patent / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008168:Lung / Q000098:blood supply / Q000601:surgery*; D019300:Medical Errors / Q000009:adverse effects*; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D020127:Recovery of Function; D015607:Stents