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Fig. 8B. 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. Balloon occlusion inferior venacavogram of underdeveloped
hepatic IVC is required to show persistence of renal-portal-hepatic venous
plexus (asterisk), which provides another pathway to decompress the
pulmonary circulation. Thus, coil embolization of persistent hepatic IVC alone
would not eliminate right-to-left shunt down hemiazygos to atrium. HA =
hemiazygos continuation of IVC.
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