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4-year-old child, previously operated for transposition of great arteries and small VSD in the neonatal period. Arterial switch operation was performed with Lecompte manoeuvre bringing the MPA anterior to the aorta. Clinical examination on follow-up showed prolonged ejection systolic murmur, and echocardiography showed flow turbulence across both the branch pulmonary arteries with peak gradient varying from 60-80 mm Hg. The cardiac CT showed severe narrowing of mid-RPA measuring 5 x 6 mm with a hilar RPA of 15 x 10 mm. The LPA was diffusely narrowed up to the hilum measuring 3 x 4 mm at the mid-segment and 7 x 6 mm at the hilum.

Plan: Cardiac catheterization, assessment of RV pressures and stenting of bilateral branch PAs.