Brief case histories of three patients who underwent cavopulmonary anastomosis 28, 27, and 26 years ago, respectively, are presented. From this limited sample the following conclusions may be drawn. (1) Long-term survival with good functional results in patients with complex congenital anomalies who undergo cavopulmonary shunting at an early age is possible. (2) Secondary changes in the circulation of the right lung such as underperfusion of the upper lobe and the development of multiple arteriovenous connections in the lower lobe do occur, maybe more often than appreciated. (3) By 15 to 20 years after their initial operation, most of these patients require additional operations such as systemic-pulmonary artery shunt or, if possible, total repair of their underlying anomaly.
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