This diagnostic angiogram of the thoracic vasculature illustrates complex post-surgical anatomy in a pediatric patient following palliative cardiac surgery. The central feature is a bidirectional cavopulmonary shunt (Glenn procedure) showing a focal stenosis at the anastomosis site between the superior vena cava and the pulmonary artery conduit. The image demonstrates a prominent, arching aorta and relatively hypoplastic pulmonary arteries. Significant pathology is noted by the presence of numerous, tortuous, and enlarged collateral vessels originating from both internal mammary arteries, which provide compensatory blood flow to the lungs. Several surgical artifacts are visible, including metallic sternotomy wires in the midline and vascular clips along the larger vessels. A metallic coil is also identifiable, indicating a previous interventional coil embolization of collateral vessels. This image serves as a clinical example of postoperative complications in congenital heart disease management, specifically highlighting stenotic shunts and the development of aortopulmonary collaterals.

This clinical photograph displays an intraoperative view of a completed pediatric cardiac surgical procedure via a midline sternotomy. The image primarily demonstrates a Bidirectional Glenn (BDG) shunt, characterized by an end-to-side anastomosis between the superior vena cava (SVC) and the superior aspect of the right pulmonary artery (RPA). Visible in the surgical field are the smooth, moist textures of vascular tissues with clear suture lines indicating the anastomotic site. The SVC has been transected from its cardiac end and repositioned to provide direct venous drainage into the pulmonary circulation. Additionally, the field reflects the state following the division of a previously placed right Blalock-Taussig (BT) shunt. The surgical area is well-visualized with anatomical landmarks including the SVC-RPA junction and the surrounding pericardial space. This visual serves as an educational reference for staged palliative surgery in patients with single ventricle physiology or complex congenital heart disease, illustrating the transition from systemic-to-pulmonary shunting to a superior cavopulmonary connection.

This intraoperative clinical photograph captures a Bidirectional Glenn (BDG) shunt procedure, specifically demonstrating an end-to-side anastomosis between the superior vena cava (SVC) and the right pulmonary artery (PA). The surgical field shows the dissected vessels held in a bloodless state. Multiple surgical instruments are visible, including vascular forceps and clamps used to manipulate and stabilize the vessel walls. A curved surgical needle and fine 6-0 polypropylene stay sutures are actively positioned at the anastomosis site to secure the junction. The interior lumen of the vascular structures is visible, showing the smooth endothelial surface and the thickness of the vessel walls. This image illustrates a critical step in pediatric cardiac surgery for congenital heart defects, emphasizing the precise suturing technique required to establish reliable pulmonary blood flow from the systemic venous circulation.

Two intraoperative clinical photographs demonstrate a bidirectional Glenn procedure (superior cavopulmonary anastomosis) in a pediatric surgical field. The images show the end-to-side anastomosis where the superior vena cava (SVC) has been surgically joined to the right pulmonary artery (RPA). Surgical instruments, including metal forceps and needle holders, are positioned around the vascular structures. Fine prolene sutures are visible at the anastomosis site, indicated by yellow arrows. The operative field includes various specialized equipment: a transparent measuring suction tip with metric markings (millimeter scale) for sizing, and multiple small-diameter orange silastic cannulas/perfusion lines. Corrugated bypass tubing and metallic retractors are also present at the periphery. This procedure aims to redirect deoxygenated blood from the upper body directly to the lungs, bypassing the right heart in the setting of right ventricular hypoplasia and severe tricuspid stenosis. The visual focus is on the vascular reconstruction and the precise surgical technique required for congenital heart disease correction.