Thrombosis in the right ventricle occurred early after bidirectional superi
or cavopulmonary shunt in 2 patients with pulmonary atresia with intact ven
tricular septum and major right ventricular coronary artery communication,
and perioperative brain infarction occurred in 1 patient. Clinicians should
be aware of the hazards of this potentially lethal complication, and trans
fusion of platelets and fresh plasma should be minimized. Although the hemo
dynamic state is good, echocardiography should be performed frequently and
strict anticoagulation should be started as early as possible. (C) 1999 by
The Society of Thoracic Surgeons.