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Most commonly used modifications of the Fontan operation. A. Right atrial (RA) to pulmonary artery (PA) Fontan connection with the right atrial appendage directly sutured to the RPA in a patient with tricuspid and pulmonary atresia. The right ventricle (RV), left ventricle (LV), mitral valve (MV), right pulmonary artery (RPA), and aorta (Ao) are labeled. B. The fenestrated lateral tunnel Fontan in which a synthetic material (eg, Gore-Tex) is used to extend a tunnel along the inside lateral wall of right atrium to the RPA, and the superior vena cava (SVC) is sutured directly to the right pulmonary artery. The fenestration in the wall of the synthetic conduit allows right-to-left shunting and depressurization of the lateral tunnel at the expense of systemic desaturation. C. Extracardiac Fontan operation is the current standard. The entire RA is bypassed by a synthetic conduit from the inferior vena cava directly to the RPA. Source: Chapter 84. Congenital Heart Disease in Adults, Hurst's The Heart, 13e The SVC is sutured directly to the RPA. Citation: Fuster V, Walsh RA, Harrington RA. Hurst's The Heart, 13e; 2011 Available at: http://mhmedical.com/ Accessed: May 10, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved
