A new modification of the Fontan operation for complex cardiac anomalies is described. The technique comprises superior vena cava-pulmonary artery anastomosis and inferior vena cava-pulmonary artery bridging via a composite conduit connected to the inferior vena cava via the right atrium, totally excluding the right heart. The procedure was applied to a patient with complex cardiac abnormalities associated with asplenia. After operation the patient had good haemodynamic function initially though he died from multiorgan failure after airway bleeding on the 24th postoperative day. The procedure is a simple alternative to the complicated atrial partition required for the conventional Fontan operation.
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