In our case, the combination of the large arterial branch from the
abdominal aorta feeding the extralobar sequestration as well as the
left to right PDA shunt, resulted in both high output cardiac failure
and renal failure, despite aggressive medical management. This
‘steal’ phenomenon has been previously described [16]. Resection
(or embolization of the feeding vessel) is required to stop this
process. Surgery in symptomatic congenital lung malformations is
associated with higher perioperative complications, longer operative-
time, increased blood loss and post-operative morbidity, with
longer lengths of stay and more frequent postoperative complications
[17]. Fortunately, our patient tolerated his thoracotomy and
resection well and immediately improved clinically. In hindsight,
although the CVR was just under 1.6, we postulate that preterm
labor may have been lifesaving for this infant, as this large
sequestration had already resulted in polyhydramnios and might
have resulted in hydrops and/or fetal demise without intervention.