Anomalous origin and malposition of the pulmonary arteries (crisscross pulmonary arteries) associated with complex congenital heart disease.

Anomalous origin and malposition of the branch pulmonary arteries is an uncommon malformation that has previously been noted only at the time of pathologic examination. Two infants with complex congenital cardiac disease had malposition of the branch pulmonary arteries (crisscross pulmonary arteries) detected by angiography and confirmed during surgery and in one case, at autopsy. The presence of this clinically unsuspected lesion complicated the accurate interpretation of both the two-dimensional echocardiographic appearance of the great vessels, and the catheter course and location during cardiac catheterization. Angiography clearly defined the crisscrossing pattern of the branch pulmonary arteries. The recognition of this malformation was important in planning and executing the surgical palliation or repair for these infants.