Kawashima procedure without fenestration in a 5-month-old infant with functional single ventricle and interrupted...

The Kawashima procedure is a variant of the bidirectional Glenn used in patients with interrupted inferior vena cava (IVC) and azygos continuation, though optimal timing and the role of fenestration remain debated. We report a 5-month-old boy with functional single ventricle physiology, transposition of the great arteries, pulmonary valve atresia with ventricular septal defect, interrupted IVC with azygos continuation, and bilateral superior vena cavae, who presented with cyanosis and failure to thrive. Imaging confirmed complex venous anomalies with hepatic venous drainage directly into the right atrium. The patient underwent a Kawashima procedure without fenestration, with stable postoperative hemodynamics, improved oxygen saturation, and an uncomplicated recovery. This case demonstrates that early Kawashima without fenestration is feasible in carefully selected infants, although exclusion of hepatic venous flow may predispose to pulmonary arteriovenous malformations, necessitating eventual Fontan completion. Favorable outcomes can be achieved in resource-limited settings with appropriate patient selection and multidisciplinary care.