Modified Fontan procedure. Methods to achieve direct anastomosis of right atrium to pulmonary artery

Experience with Fontan operations suggests that techniques which utilize autogenous structures exclusively to achieve right atrium-pulmonary circuit connection may be preferred. Valves probably are not required in the circuit and in some cases have become obstructive with time. A large-diameter direct anastomosis of the right atrium to the pulmonary artery nearly always is possible and provides a modification of the Fontan procedure which combines favorable qualities of simplicity, all autogenous material, and posterior position which is free of the risks of compression. There also may be improved hemodynamics with this modification. Options to achieve this anastomosis depending on relations of the great arteries, previous operations, and other anatomic variations are described in eight patients.