A preterm infant with bronchopulmonary dysplasia presented with clinical and Doppler echocardiographic features suggesting a left-to-right ductal shunt. The duct was ligated surgically. Clinical and echocardiographic signs did not change after ligation. Detailed colour Doppler examination ultimately showed several aortopulmonary collateral arteries giving rise to continuous turbulent flow in the main and left pulmonary arteries, similar to that seen with left-to-right ductal shunting.
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