Anomalous left pulmonary artery: rare case, uncertain embryology and off-pump approach.

Left pulmonary artery from descending aorta, left-sided arch and patent ductus arteriosus is a rare congenital anomaly. Only one such case has been reported before, which was repaired in the neonatal period and the authors suggested that current theories of embryology failed to explain such a combination. Early and often bilateral pulmonary vascular disease is common with such defects. We present an 8-month-old baby, with this anatomy, who was repaired using an off-pump approach, to minimize the risk of postoperative pulmonary hypertensive crisis and propose a "modified ontogenic theory" to explain the embryology.