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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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