Hypoplastic left heart complex is a cardiac malformation at the mildest end of the spectrum of hypoplastic left heart syndrome. Recently, biventricular repair was proposed for such patients without retrograde flow to the ascending aorta. However, the preoperative course of these patients is unclear. This report describes a unique case of this complex with a retrograde flow to the ascending aorta and a restrictive foramen ovale at birth in which the patient ultimately underwent biventricular repair after transient pulmonary congestion and full reversal of aortic and ductal flow.
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