Fig. 2

(A and B) Transthoracic echocardiography depicts a significant gradient at the origin of the right pulmonary artery (A). Pulmonary computed tomography angiography reveals a significant stenosis at the origin of the right pulmonary artery (B). (C, D, E, F, and G) Selective right pulmonary artery injection shows significant stenosis in the upper and lower lobar branches (C). Kissing balloon dilation of both branches is done (D). Injection after balloon percutaneous angioplasty shows residual stenosis in both branches (E). Separate and simultaneous balloon percutaneous angioplasty procedures are performed on both branches using larger balloons (F). Final angiography shows mild residual stenosis in the lower branches with acceptable blood flow in the distal branches (G)