Extracardiac Fontan in apicocaval juxtaposition

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Extracardiac total cavopulmonary connection (TCPC) is a widely adopted Fontan modification.
• Optimal extracardiac conduit routing remains a challenge in patients with complex situs anomalies and venous drainage variations.

Observation:

• This report describes three cases of apicocaval juxtaposition, a rare situs anomaly.
• In these cases, situs inversus was present with the cardiac apex and inferior vena cava on the left, and the superior vena cava (Glenn) on the right.

Findings:

• The study discusses technical options for extracardiac conduit routing in these specific anatomical variations.
• Surgical intervention in these cases yielded excellent short- and midterm results.

Implications:

• These findings offer valuable insights into managing complex Fontan modifications in patients with challenging anatomy.
• The described surgical techniques may improve outcomes for Fontan procedures in cases of apicocaval juxtaposition.