The case of a boy who had an absent pulmonary valve, tricuspid atresia, intact ventricular septum, coronary-to-right-ventricular fistula, and dysplasia of the right ventricular free wall is described. At the bidirectional cavopulmonary shunt procedure, the right ventricular free wall was opened and two major fistula orifices to the cavity were closed with sutures. A fenestrated circular patch was placed in the main pulmonary artery and the right ventricular free wall was plicated. The patient then underwent completion for total cavopulmonary connection. Follow-up catheterization showed that the pulmonary artery was partially excluded with minimal pressure wave conduction from the right ventricle, which significantly shrank. This new approach seems to be effective and reproducible in this particular situation.
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