occur early or late after the creation of cavopulmonary connections. The reopening can cause profound cyanosis due to veno-venous rightto-left shunting. 1,2 If the reopened left superior caval vein is small, or has intrinsic stenosis, embolisation using coils is considered the treatment of choice. 3,4 In the case we report here, due to the large size of the venous channel and the absence of stenosis, we closed the vein using an Amplatzer ductal occluder. Case reportThe patient was a 7-year-old boy with usual atrial arrangement, tricuspid atresia with discordant ventriculo-arterial connections, a restrictive ventricular septal defect, and coarctation of the aorta with a hypoplastic aortic arch and right descending aorta. Repair of the aortic arch had been performed at the age of 8 weeks, followed by a Damus-Kaye-Stansel anastomosis, atrioseptectomy and construction of a central aorto-pulmonary anastomosis at the age of 10 weeks, and a total cavopulmonary connection at the age of 2 years and 5 months, respectively. A 3 mm fenestration was created in the baffle. Persistence of the left superior caval vein had been excluded by angiography prior to the total cavopulmonary connection. The saturation of oxygen measured transcutaneously at discharge after the total cavopulmonary connection was 95%. The patient was then readmitted for hemodynamic and anatomic evaluation at the age of 7 years because of increasing cyanosis.Clinical findings at admission revealed a good general state, but cyanosis was noted, with an oxygen saturation of 82% at rest and of 79% during submaximal exercise. Transoesophageal echocardiography showed a small fenestration of the caval venous tunnel, measuring 2.5-3 mm, which permitted a right-to-left shunt.Catheterisation was performed under general anaesthesia and continuous infusion of heparin at 10,000 IU/m 2 /day. The haemodynamics were satisfactory, with a moderately increased central venous pressure of 12 mmHg. The total cavopulmonary connection was unrestricted, and the pulmonary occlusion pressure was 8 mmHg. Under mechanical ventilation, and at an inspired oxygen fraction of 0.30, mixed Abstract A 7-year-old boy developed increasing cyanosis after a total cavopulmonary connection with a 3 mm fenestration in the baffle. Catheterisation performed 4 years and 7 months after the operation showed reopening of a left superior caval vein draining into the pulmonary venous atrium. Due to the large size of the left superior caval vein, and the absence of intrinsic stenosis, we chose to use an Amplatzer ductal device to occlude the reopened vein. The procedure was safe and successful.

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