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(D) Kawashima procedure: in patients with a single ventricle along with IVC interruption and azygos continuation, cavopulmonary connection is created by division of the SVC distal to the drainage of the azygos vein and anastomosis of the cranial aspect of the SVC to the pulmonary artery. The SVC is also transected and anastomosed to the superior wall of the RPA. (C) Extracardiac Fontan operation: a tube graft or a conduit is placed entirely outside the atrium, and it connects the transected IVC and the pulmonary artery, bypassing the right atrium. The SVC is divided and reanastomosed to the superior and inferior walls of the RPA.

(B) Lateral tunnel Fontan operation: IVC is connected to the pulmonary artery via the intra-atrial lateral tunnel made of the posterior atrial wall and a prosthetic patch. (A) Atriopulmonary Fontan operation: the right atrium or the right atrial appendage is directly anastomosed to the pulmonary artery. The purpose of this article is to familiarize radiologists with the surgical techniques of the Fontan procedure, to describe the technical considerations for optimal image acquisition and the expected normal postoperative anatomy, and to illustrate the imaging findings of postoperative complications in these patients.ĭiagrams showing various anatomies of classic and modified Fontan procedures. Accordingly, radiologists are increasingly likely to encounter long-term complications of the Fontan pathway in certain cardiac patients. Consequently, late complications of the Fontan procedure are being increasingly encountered, particularly in patients with poor hemodynamics. Advances in surgical techniques with modified Fontan procedures have led to improved long-term results and increased life expectancy in such patients. It is performed in patients with functional univentricular heart physiology in which biventricular repair is not possible. The Fontan pathway is the result of a palliative surgical procedure achieved by direct anastomosis of systemic veins to the pulmonary arteries, bypassing a ventricle.

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