Elusive pulmonary venous confluence-to-hepatic vein connection leading to heart failure.

A persistent omphalomesenteric vein (POMV) maintaining a link between the pulmonary venous system and the infracardiac hepatic venous system can lead to significant left-to-right shunting. To the best of the authors' knowledge, POMV causing significant left-to-right shunting has been unreported previously, especially in association with type B interrupted aortic arch. This report describes this association in a child who had chronic heart failure even after successful repair of interrupted aortic arch and ventricular septal defect. Subsequent percutaneous device closure of the POMV using an Amplatzer vascular plug II led to resolution of the child's heart failure.