Novel modification of total cavopulmonary connection for isolated hepatic vein

A surgeon needs an innovative technique to establish a Fontan circulation for a patient who has a widely separated hepatic vein from the inferior vena cava. The inferior vena cava was redirected by placing a trimmed GoreTex baffle (W. L. Gore and Associates, Flagstaff, AZ) on the internal side of the atrium connecting the hepatic venous flow, and then directing it to the extra-atrium. Another extracardiac half-circumferential GoreTex baffle was sutured to the epicardial atrial wall and to the pulmonary artery opening. This procedure is efficacious for patients with an isolated hepatic vein and has advantages in terms of using less synthetic material in the conduit.