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A case is presented illustrating delayed failure of a right Glenn anastomosis due to patency of the superior vena cava-right atrial (SVC-RA) junction. Clinical deterioration was rectified by a unique nonoperative approach. A transvenous catheter was designed, constructed, and used to accurately place an umbrella-like occlusive wafer at the SVC-RA junction. In this manner the integrity of the cavopulmonary shunt was re-established. A gratifying and uncomplicated palliation has thus far been achieved.

In addition to recording the motion of the mitral, tricuspid, aortic, and pulmonic valves, echocardiography can identify right and left ventricular cavities and the interventricular septum. Disorders such as atrial-septal defect, valvular and subvalvular aortic stenosis, pulmonic stenosis, Ebstein's anomaly of the tricuspid valve, and the hypoplastic left-heart syndrome can readily be evaluated by echocardiography. In tetralogy of Fallot and truncus arteriosus, discontinuity between the anterior aortic wall and septum with overriding aorta has been demonstrated. Doubleoutlet right ventricle is associated with posterior aortic wall and mitral valve discontinuity. In disorders such as single ventricle, tricuspid atresia, and endocardial cushion defect with common A-V canal, echocardiographic demonstration of the absence of the interventricular septum has provided the clinician with valuable information. Newer techniques such as compound-B ultrasonography, which produces a two-dimensional cross-sectional image of intracardiac structures, and multiscan echocardiography will enhance the use of conventional echocardiography by providing a more accurate anatomic display of cardiac chambers and outflow vessels.

The case is presented of a patient with congenital tricuspid stenosis who was treated successfully by a palliative open operation. The preoperative diagnosis was tricuspid atresia. At operation, however, congenital tricuspid stenosis was detected and managed by commissurotomy.. The postoperative course was very good. Later, the associated ventricular septal defect (VSD), pulmonary annular stenosis, and probably the atrial septal defect (ASD) will be corrected. We emphasize the importance of diagnosing congenital tricuspid stenosis correctly, because of the possibility of operating upon the valve itself.

In a 13-day-old, 1,300 gram premature infant with tricuspid atresia, a Potts-Smith anastomosis was successfully performed. We used a neurosurgical vessel clip, smaller than the smallest available vascular clamp, to side-clamp the descending aorta. This report appears to be the first of the construction of a Potts-Smith shunt in an infant of this size.