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Fig. 5B. —4-year-old girl with group 2 anomaly and left atrial isomerism, unbalanced atrioventricular canal defect (right dominant), pulmonary and left atrioventricular valve atresia, transposed great arteries, and azygos continuation of inferior vena cava. Previous surgeries (not shown) included right modified Blalock-Taussig shunt, atrial septectomy and resection of left atrial membrane, left pulmonary arterioplasty, and Kawashima procedure [7] (B). Superior venacavogram shows Kawashima procedure or anastomosis of azygos (Az) and superior vena cava (SVC) with pulmonary artery (PA). Note decompression down azygos (arrow) to right atrium via renal-portal-hepatic venous plexus (See asterisk, Fig. 5A), causing persistent and unexpected arterial desaturation after surgery.