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Although indications for a Fontan procedure have broadened, some patients, in the past, were ineligible for the Fontan completion after a Glenn procedure and thus suffered the limitations of the Glenn procedure-namely desaturation, arrhythmia and reduced quality of life. If examined more closely, however, completion may yet be feasible for such patients. We present here a complex case of asplenia, dextrocardia and total anomalous pulmonary venous return (1b) where the Fontan procedure was successfully completed 12 years after the Glenn procedure. A unique surgical strategy incorporating intra-atrial total cavopulmonary connection and atrioventricular valve repair contributed to our success.

Intracardiac total cavopulmonary connection in an asplenic adult male 12 years after Glenn procedure for total anomalous pulmonary venous return (1b)