Right pulmonary artery--left atrial communication. A case report and literature review.

A 22-month-old girl with Down's syndrome with a direct communication between the right pulmonary artery and left atrium leading to systemic desaturation is presented. She also had an atrial septal defect of the secondum type, which spontaneously closed. She underwent successful ligation of the abnormal communication. The literature is reviewed and, considering the high incidence of cerebral and systemic emboli, early surgical intervention is recommended.