Pulmonary artery angiography may be advisable in order to delineate anatomic details prior to surgical correction. This permits diagnosis of variations in right and left pulmonary artery anatomy that may not be apparent from noninvasive studies and that can alter the surgical approach. Origin and course of the anomalous left pulmonary artery is best demonstrated by contrast injection into the main pulmonary artery filming in an oblique view with steep cranial angulation of 60-70 degrees. Bronchoscopy generally is not recommended. Some recommend bronchoscopic evaluation of selected surgical candidates because surgical reconstruction of the trachea or bronchi may be necessary if the airway compromise is severe.
Medical care is supportive until the patient can undergo definitive surgical correction.
Treat pneumonia with appropriate antibiotics. Stabilize the patient and make arrangements for surgery as soon as possible. Infants without airway obstruction and with minimal symptoms may not require surgical intervention. This scenario, however, is the rare exception. Survival of symptomatic infants is unlikely without early surgical intervention.