Explain Extra Cardiac Conduit Fontan ?

This can be done with or without cardipulmonary bypass. First step is to make a bi-directional Glenn shunt. The main pulmonary artery is clamped, transacted and both ends sutured off. A wide anastomosis is made between a PTFE graft and under aspect of right pulmonary artery and on to main pulmonary artery. Tile graft is then clamped at its mid portion. IVC is mobilised and taped. Very low IVC cannulation is doing after full heparinisation (3 mg/Kg) and it is connected to another cannula in the right atrial appendage to form a shunt for IVC blood to flow to atrium. IVC is doubly clamped and its cardiac end over sewn. The end of the conduit is then anastomosed to the cut lower end of IVC to complete the extra cardiac conduit. For decompression, an anastomosis teasing 4,5 or 6 mm can be made between the conduit and right atrium. This can also be done using a Goretex graft of the same dimension sutured to RA on one side and the extra cardiac conduit on the other.