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What are the two primary versions of the modified Fontan procedure?
Lateral tunnel vs extracardiac conduit. With the lateral tunnel, a synthetic or pericardial baffle is placed inside the right atrium in anteroposterior plane, dividing the right atrium into halves and creating a dedicated channel for systemic blood to pass from the IVC to the inferior cavopulmonary anastomosis. With the extracardiac conduit, the IVC is disconnected from the right atrium, and a synthetic conduit is attached to connect the transected IVC to the inferior cavopulmonary anastomosis.
- Double inlet left ventricle configuration, featuring large ASD (asterisk) connecting right and left atria (hypoplastic RV and large VSD not depicted)
- Inter-atrial baffle (yellow arrow). It is situated between the anterior midatrial wall to the posterior margin of the ASD, bisecting the atrial chamber into the lateral channel and medial neoatrium
- Contrast streaming from vena cava to the right neoatrium, forming a right-to-left shunt. This most likely indicates a patent fenestration through the baffle, although baffle leak could appear similar
- Maximum intensity projection depicts the total cavopulmonary shunt
- Collaterals which have formed between pulmonary arteries and aorta. (the origins of the bronchial artery appears to originate more distally at the proximal descending aorta