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Fig. 8A. —4-year-old boy with left atrial isomerism, double outlet right ventricle, rightward and anterior aorta, atrioventricular canal defect, bilateral superior vena cavae, hemiazygos continuation of inferior vena cava (IVC) to left superior vena cava, and hypoplastic hepatic IVC. Previous interventions (not shown) included pulmonary artery banding, pulmonary artery angioplasty, and Kawashima procedure [7] with occlusion of right superior vena cava. Inferior venacavogram shows hemiazygos (HA) continuation of IVC with persistence of patient, albeit underdeveloped, IVC. Patent IVC allows decompression of systemic venous return away from pulmonary artery to atrium, leading to hypoxemia.