Coronary-to-pulmonary artery collateral in tetralogy of Fallot.

Angiography in a 14-year-old boy with cyanosis since birth confirmed the diagnosis of tetralogy of Fallot with a subaortic ventricular septal defect, large overriding aorta, severe pulmonary stenosis, and a large collateral arising from the left circumflex artery. The collateral was isolated and ligated at its origin, and the patient underwent an uneventful repair with ventricular septal defect patch closure, infundibular resection, pulmonary valvotomy, and right ventricular outflow tract reconstruction with an autologous pericardial patch.