Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 131 133 EN Yazdan Ghandi Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran Akbar Shafiee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrazad Sharifi Amir Almomenin Hospital, Arak University of Medical Sciences, Arak, Iran. Najmeh Sadat Bolandnazar Mafi Military Hospital, Shush, Khuzestan, Iran 2017 06 19 2017 06 19 The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported.  A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations. https://rhythm.tums.ac.ir/index.php/jthc/article/view/737 https://rhythm.tums.ac.ir/index.php/jthc/article/download/737/600