PMC5671401_01
Images of the left bronchus during bronchoscopy. Dilated blood vessels with an erythematous and corrugated mucosa are present in the left main bronchus at 13 years of age (upper). Small blood vessels without an erythematous mucosa are present in the left main bronchus two months after balloon dilation of the left upper pulmonary vein and placement of a vascular plug in the left lower pulmonary artery (lower).
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An image of the left bronchus is shown in Fig. 1. Amplatzer  Vascular Plug II was placed in the proximal left lower pulmonary artery. An image of the left bronchus, two months after catheter-mediated interventions, is shown in Fig. 1.
Pulmonary vascular anatomy and perfusion. A manual injection of contrast was performed with transient balloon occlusion of the left lower pulmonary artery. There is pruning and decreased arborization of the peripheral vessels (left upper). There is indistinct filling of small peripheral pulmonary veins with no detectable central left lower pulmonary vein (right upper). A vascular plug is positioned in the proximal left lower pulmonary artery (left lower). Contrast fills the left upper and right pulmonary arteries well. There is a limited amount of blood flow to the left lung 42 months following balloon dilation of the left upper pulmonary vein and occlusion of the left lower pulmonary artery (right lower). The following geometric means for the distribution of flow to each lung zone using anterior and posterior images were reported: right upper 16.6%, right middle 40.0%, right lower 30.3%, left upper 6.3%, left middle 5.8%, left lower 1.0%.
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Pulmonary arterial angiograms immediately before and after placement of the vascular plug are shown in Fig. 2. Fig. 2 shows a lung-perfusion scan with a limited amount of blood flow to the left lung 42 months following the interventions.