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patient underwent off-pump stage II palliation at 3 months of age with the placement of a right Glenn shunt, central shunt placement, and ligation of the left-sided superior vena cava above the level of the azygos vein. Postoperative echocardiography showed right ventricular hypertrophy with preserved systolic function, mild neoaortic valve insufficiency, unobstructed PA flow, and mild to moderate obstruction at the junction of the neoaorta and the native descending aorta.At 4 years of age, the patient underwent pericardial patch augmentation of the neoaorta with excision of the previously fixed ductus arteriosus, anastomosis of the azygos continuity of the inferior vena cava to the left PA (Kawashima procedure), central shunt takedown, and augmentation of the central PA with a 12 mm GORE-TEX graft (W. L. Gore & Associates, Newark, Del) on cardiopulmonary bypass. Her postoperative course was uneventful, with echocardiography showing minimal neoaortic valve regurgitation with no obstruction of the neoaorta, PAs, Glenn, and Kawashima anastomoses. Pathologic examination of the excised ductus arteriosus tissue is shown in Figure 2, C.The patient presented at 8 years of age with increasing cyanosis secondary to progressive pulmonary arteriovenous malformations, and thus underwent connection of the hepatic veins to the right PA by using a 16-mm GORE-TEX graft with an uneventful postoperative course.At most recent follow-up, the patient is 8 years old and growing well. There is excellent right ventricular systolic function, mild tricuspid regurgitation, and no neoaortic valve regurgitation on echocardiography. The