Muhammad Aanish Raees, MBBS, Driss Mazhar, DFGSM, Jason T

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Bidirectional Inferior Cavopulmonary Anastomosis: Pre-Fontan Interim Palliation Muhammad Aanish Raees, MBBS, Driss Mazhar, DFGSM, Jason T. Christensen, MD, David Andres Parra, MD, Stacy Killen, MD, David P. Bichell, MD The Annals of Thoracic Surgery Volume 104, Issue 4, Pages e329-e331 (October 2017) DOI: 10.1016/j.athoracsur.2017.04.056 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Clinical application of bidirectional inferior cavopulmonary anastomosis is shown in a patient with complex double-outlet right ventricle and transposition of the great arteries. (Left) Preoperative anatomy. (Right) Postoperative anatomy. The main pulmonary artery (PA) was anastomosed directly to the transected inferior vena cava (IVC). Superior vena cava (SVC) blood flow was maintained in unobstructed continuity with the atrium. The Annals of Thoracic Surgery 2017 104, e329-e331DOI: (10.1016/j.athoracsur.2017.04.056) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Cardiac catheterization contrasting the bidirectional inferior cavopulmonary anastomosis, before Fontan completion, is seen in (Left) front and (Right) side views. The splanchnic and lower body effluent drains into the inferior vena cava and flows straight to both pulmonary arteries through a Y-shaped anastomosis. The upper body venous circulation (not shown) remains connected to the right atrium. The Annals of Thoracic Surgery 2017 104, e329-e331DOI: (10.1016/j.athoracsur.2017.04.056) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The superior vena cava (SVC) and inferior vena cava (IVC) are shown draining into the pulmonary arteries. The Y-shaped anastomosis of the IVC to the pulmonary arteries offers better flow dynamics and equal distribution of hepatic effluent to the lungs. (LPA = left pulmonary artery; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2017 104, e329-e331DOI: (10.1016/j.athoracsur.2017.04.056) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions