I N THE LAST TWO DECADES various types of systemic pulmonary artery (S-PA) shunts have been used to palliate children with cyanotic heart lesions. Some eventually have been totally corrected, some have died as a result of their original anomaly or from complications of the shunt itself, and some continue reasonably well palliated. However, many of these patients have lesions not amenable to total correction, are poorly palliated and show signs of progressive deterioration. This report deals with this last group. In infants with noncorrectable cyanotic heart disease we would prefer to perform a Glenn shunt as the primary procedure. The high pulmonary vascular resistance and frequent hypoplastic pulmonary arteries found in these neonates both tend to inhibit blood flow from the cava to the pulmonary circuit. The delayed slip knot ligation of the azygos vein introduced by Bargeronl has allowed better results in small infants, but generally we prefer a high-pressure systemic pulmonary artery (S-PA) shunt in tiny babies if surgical intervention is necessary. The high pressure shunts commonly employed are the Potts-Smith, Waterston, and Blalock-Taussig. Potts and Waterston shunts are frequently associated with too much blood flow to the lungs resulting in increased heart work, congestive heart failure and pulmonary congestion. Blalock-Taussig shunts, on the other hand, are more frequently “outgrown” and fail to meet the patient’s needs. Increased pulmonary vascular resistance is a rare but serious complication of highpressure shunts, a problem not encountered with cava-pulmonary artery (C-PA) shunts. It seems feasible in those patients with high-pressure shunts who are deteriorating for any reason to convert to or add a Glenn (C-PA) shunt which has proven to be an excellent long-term palliative procedure for complex noncorrectable cyanotic heart lesions.2,3 Early in our experience in this series the plan was to obliterate the highpressure shunt and convert to a low-pressure C-PA shunt. Since this would have required bilateral thoracotomies in most cases we elected to simply add the C-PA shunt to the opposite lung. As experience grew it became apparent that the ideal palliation is derived from a C-PA shunt to one lung and a small S-PA