The posterior tunnel Fontan: A different approach to lateral tunnel Fontan.

Completing the Fontan circulation in patients with heterotaxy syndrome and complex cardiac anatomy presents unique surgical challenges. We report a case in which a modification of an intra-atrial lateral tunnel (LT) technique was utilized during the Fontan procedure. The patient, who had previously undergone staged single-ventricle palliation at our institution, was admitted with worsening cyanosis for Fontan completion. Intraoperatively, the intra-atrial tunnel was positioned posteriorly to redirect the hepatic venous return to the left atrial appendage with a posterior tract running on the left of the pulmonary veins. This case provides a variation of the lateral tunnel technique.