Congenital heart disease with cyanosis beginning at age three.
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An increasing right-to-left shunt after a total cavopulmonary connection was treated by banding the separate liver vein. As a variation on a fenestrated total cavopulmonary connection, this liver vein was not connected with the intercaval tunnel. After a few days, the shunt increased to an unacceptable level. This was treated by banding the liver vein, which was connected with the right-sided atrium and turned out to be only part of the venous drainage of the liver.
This case report demonstrates the utility of transesophageal echocardiography in the rapid diagnosis of cardiac injury from blunt thoracic trauma. Initial transesophageal echocardiography identified a flail tricuspid valve leaflet and regurgitation in a patient with jugular venous distention and hemodynamic instability. Progressive hypoxemia prompted repeat transesophageal echocardiography with contrast enhancement, which revealed opening of the foramen ovale and a right-to-left interatrial shunt. Operative repair of the lesion was lifesaving.
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