(fig 2a). A right atrial cineangiogram showed direct emptying of the contrast material into the left ventricle via the primum atrial septal defect and common atrioventricular valve (fig 2b). The left atrium was simultaneously opacified, unlike classic tricuspid atresia in which there is sequential opacification of the right atrium, left atrium, and left ventricle. The right ventricle was not directly opacified from the right atrium. The child underwent a right BlalockTaussig shunt which improved systemic arterial oxygen saturation (84%).