Blood transfusion is usually required to perform open cardiac surgical repair in small infants, but the use of blood might be rejected by parents on religious grounds. We operated on a 1.4 years old boy with ventricular septal defect (VSD) and severe (grade 3/4) mitral regurgitation (MR) due to elongated anterior chordae, whose mother was a “Jehovah's witness” sympathizer, initially rejecting any blood transfusion. In view of the deteriorating condition of the infant, and the inadequacy of the pulmonary artery banding alone as therapeutic modality, the mother was persuaded to ultimately consent to controlled cross-circulation between her and the child. The arterial blood was pumped with a roller pump from the mother's femoral artery to the infant's ascending aorta; caval venous return of the infant was drained by gravity into a reservoir and then pumped into the femoral vein of the mother by a second roller pump. A large membranous ventricular septal defect and the mitral regurgitation were repaired (patch closure of the VSD, and shortening of the elongated anterior papillary muscle chordae in conjunction with Kay's type mitral annuloplasty for the MR) during a cross-circulation time of 212min. 2.2 years after the operation, both, the infant and the mother, enjoy good health.

Double drainage sites from a common venous confluence of the pulmonary veins of a mixed total anomalous pulmonary venous connection is a rare condition that is called a “double connection.” There have been very few reports of reoperation for minor drainage of a double connection. A 28-year-old male with double connection type (Ia: major drainage + IIa: minor drainage) mixed total anomalous pulmonary venous connection (TAPVC) was referred to our institution. He had undergone TAPVC type Ia (major drainage) repair at the age of 1 year. Postoperative enhanced computed tomography showed residual TAPVC IIa (minor drainage) at the age of 15 years. Therefore, the definitive diagnosis was double connection-type mixed TAPVC. Residual shunt gradually increased, and cardiac catheterization revealed an increased pulmonary blood flow/systemic blood flow ratio. Echocardiography showed enlarged shunt vessel and mild tricuspid regurgitation. Catheter intervention was considered too risky and, therefore, we performed patch closure of the residual shunt through a right atriotomy. The postoperative course was uneventful, and follow-up computed tomography showed shrinkage of the shunt vessel without any thromboembolic events.