Continuous right-to-left ductal flow in a newborn

We describe a 7-day-old newborn who presented with arterial desaturation and respiratory distress. The evaluation showed a duct with a continuous right-to-left shunt and an anomalous origin of the right pulmonary artery from the aorta. We discuss the hemodynamics leading to continuous right-to-left ductal flow and the subsequent intraoperative evaluation that resulted in a successful single-stage surgical repair of this interesting case.