Customization of the Fontan Y-Graft: Are Unequal Branches Necessary for Optimal Hepatic Flow Distribution?

Due to surgical complexity and clinical complications, single ventricle defects are among the most severe and challenging congenital heart diseases to treat. Patients usually undergo a three-staged surgery. The first stage consists of shunt insertion and aortic reconstruction in a Norwood procedure. In the second stage, the Bidirectional Glenn procedure, the superior vena cava (SVC) is disconnected from the heart and redirected into the pulmonary arteries (PA’s). In the third and final stage, the Fontan procedure, the inferior vena cava (IVC) is connected to the PA’s via a straight Gore-Tex tube, forming a T-shaped junction with or without offset.