 Hi everyone, today I will like to discuss an infrequent anomalous riot pulmonary artery origin from ascending avota along with patent ductus arteriosus, a case report with literature review. Demographically, avotic origin of pulmonary artery is an infrequent cardiac anomaly less frequently documented with an estimated prevalence of about 1% amongst which riot pulmonary artery is more common than the left one. What is problem here is a left untreated frequent episodes of lower respiratory tract infection and pulmonary arterial hypertension are common consequences. Despite causing significant morbidity, avotic origin of pulmonary artery is not sought out in patients having simultaneous patent ductus arteriosus. With objectives of to document a case of avotic origin of pulmonary artery with patent ductus arteriosus and explain the pathology associated, its clinical implications, its consequences, management options available and relevant literature review. Case history, a young boy of 14 years presenting with medical research council Grade 3 Drismia curve and code with past history of frequent admissions for lower respiratory tract infection was having normal birth history. On examination, we found grade 2 clubbing, fast breathing, low O2 saturation, tricuspid regurgitation, increased thoracic girth and left costofrenic fluid knot. He was subsequently subjected to 2D echocardiography with revealed right arterial dilatation, tricuspid flow regurgitation, absence of typical pulmonary trunk bifurcation pattern with non-visualization of right pulmonary artery. CXR was turned and revealed cardiomegaly. Patient was subjected to multi-slice CT pulmonary angiography on the ground of clinical examination and echocardiography findings. What we found on imaging is interstitial and bronchovascular markings were prominent along with cardiomegaly on multi-slice CT scanogram. As well as prominent interstitial and bronchovascular markings are evident. On medial senile window axial view, what we can see is a right pulmonary artery anomalously arising from ascending aorta. Further, we can see that type 3 patent ductus arteriosus is there between pulmonary trunk and descending aorta. On medial senile window axial view of multi-slice CT pulmonary angiography. Then severe right arterial dilatation, right ventricular hypertrophy, interventricular septal hypertrophy were found on medial senile window axial view of multi-slice CT pulmonary angiography. Generalized moderate cardiomegaly is also evident. On medial senile window axial view, changes of pulmonary arterial hypertension in the form of reversal of ascending aorta to main pulmonary artery ratio that was less than 1 along with mild left side pleural effusion. Here we can see smooth interlobular septal thickening, interlobar fissural thickening as well as prominent peribronchovascular interstitium. These findings were suggestive of interstitial pulmonary edema. To be discussed here is aortic origin of pulmonary artery is a rare cardiac anomaly amongst which aberrant origin of right pulmonary artery is more common than the left pulmonary artery. Right sided aortic origin of pulmonary artery. Right sided are usually associated with patent ductus arteriosus like in our case. Most mechanism behind it is incomplete migration of right sixth aortic arch. Right sided proximal aortic origin of pulmonary artery, whereas for distal right aortic origin of pulmonary artery, absence or early regression of the distal right sixth aortic arch is suggested. Left sided aortic origin of pulmonary artery. Left sided aortic origin of pulmonary artery are always associated with tetralogy of phallus or aortic arch anomalies. Proposed mechanism behind it is for left sided aortic origin of pulmonary artery improper fusion of the left pulmonary artery to the main pulmonary artery due to poor development of left sixth arch is the proposed mechanism. Postulated mechanisms leading to complications. Postulated pulmonary artery blood flow circulating vasoconstrictor substances, neurogenic compounds flowing from the unprotected lungs will lead to pulmonary hypertension. Pulmonary edema and congestion due to abnormally increased blood flow to the lungs will lead to recurrent lung infections. Surgical interventions in form of management options are direct implantation end to end anastomosis with a synthetic graft, homograft patch and aortic ring flap are the methods used to reattach aberrant pulmonary artery to main pulmonary trunk. To be concluded what we found is aortic origin of pulmonary artery on right side with type 3 pit inductors, artyrosis and findings related to consequent complications. Patient was explained the severity of the conditions and corrective surgical options available which were denied. The take home message here is aortic origin of pulmonary artery being a rare condition need to be looked out for at earlier age before irreversible consequences occur. Surgical management at earlier age presents with better prognosis. These are the references were referred to. Thank you everyone.