Sir,
We thank Piacentini and colleagues for their comments on our article. We agree that aortopulmonary collateral arteries are not so uncommon in association with pulmonary atresia in the setting of Fallot's tetralogy.1–3 We also recognise that their association with right isomerism is well documented.4 The association with right isomerism and extracardiac totally anomalous pulmonary venous connection, however, is rare,5 and this was the echocardiographic diagnosis in our case. Following the successful repair of the anomalous pulmonary venous connection, we did not expect high pulmonary blood flow. Further investigation in the form of catheterisation and angiography revealed redundant aortopulmonary collateral arteries in presence of pulmonary arteries of reasonable size. The successful occlusion of these arteries with coils optimised the flow of blood to the lungs, and helped us wean the patient successfully from ventilation. Our case warranted publication based on the interesting temporal profile of discovery of this rare association. We ourselves also emphasized the indications for cardiac catheterisation and angiography.
