{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T14:41:19Z","timestamp":1776523279553,"version":"3.51.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Tetralogy of Fallot with pulmonary atresia (ToF-PA) requires precise delineation of extracardiac pulmonary blood supply to guide optimal palliation, especially in duct-dependent physiology. We report an 8-month-old infant with late-onset central cyanosis and recurrent cry-triggered hyper cyanotic spells. Computed tomography (CT) thoracic angiography showed classic ToF with short-segment pulmonary atresia, a malaligned perimembranous ventricular septal defect, and hypoplastic yet confluent branch pulmonary arteries. A long, tortuous patent ductus arteriosus (PDA) provided dominant pulmonary flow, with severe focal juxtaductal stenosis just before insertion into the left pulmonary artery and reduced distal pulmonary arborization. A small ostium secundum atrial septal defect was identified. Minor systemic collaterals were seen, without large dominant major aortopulmonary collateral arteries, suggesting duct-dominant physiology potentially amenable to pulmonary artery rehabilitation. This case highlights late deterioration from progressive PDA\u2013left pulmonary artery narrowing and underscores CT angiography as a key decision map for catheter or surgical palliation and operative planning.<\/jats:p>","DOI":"10.1093\/jscr\/rjag274","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:51:33Z","timestamp":1774615893000},"source":"Crossref","is-referenced-by-count":0,"title":["Late-onset hypercyanotic spells in duct-dominant Tetralogy of Fallot with pulmonary atresia from juxtaductal PDA\u2013LPA stenosis: CT angiography for preoperative mapping"],"prefix":"10.1093","volume":"2026","author":[{"given":"Aditya","family":"Pachwa","sequence":"first","affiliation":[{"name":"Mamata Academy of Medical Sciences , Hyderabad 500118 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siddartha R","family":"Gangapuram","sequence":"additional","affiliation":[{"name":"Mamata Academy of Medical Sciences , Hyderabad 500118 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pranav R","family":"Pariyada","sequence":"additional","affiliation":[{"name":"Mamata Academy of Medical Sciences , Hyderabad 500118 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6635-5226","authenticated-orcid":false,"given":"Lakshya N","family":"Samineni","sequence":"additional","affiliation":[{"name":"College of Medical Sciences Teaching Hospital , Chitwan, Bharatpur 44200 ,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2026041809494595800_ref1","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1177\/1089253220920480","article-title":"Tetralogy of Fallot with pulmonary atresia: anatomy, physiology, imaging, and perioperative 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