1. Extracardiac conduit fontan procedure without cardiopulmonary bypass
Doff B McElhinney, MD, Edwin Petrossian, MD, V.Mohan Reddy, MD, Frank L Hanley, MD 
The Annals of Thoracic Surgery 
Volume 66, Issue 5, Pages (November 1998)
DOI: /S (98)00928-X

2. Fig 1
Purse-string sutures are placed in the right atrial appendage and low in the inferior vena cava for cavoatrial bypass during the inferior vena cava to conduit anastomosis. In case bypass is required, pursestring sutures are also placed in the ascending aorta and high in the superior vena cava. A side-biting clamp is placed along the underside of the pulmonary artery and and an anteroinferior pulmonary arteriotomy is performed.
The Annals of Thoracic Surgery  , DOI: ( /S (98)00928-X)

3. Fig 2
Using continuous polypropylene suture, the beveled superior end of the conduit is anastomosed to the arteriotomy in the segment of pulmonary artery isolated by the side-biting clamp.
The Annals of Thoracic Surgery  , DOI: ( /S (98)00928-X)

4. Fig 3
After completion of the conduit to pulmonary artery anastomosis, the side-biting clamp is removed from the pulmonary artery and the conduit is deaired and cross-clamped. Inferior vena cava to right atrium bypass is established with two venous cannulas connected together. Two straight vascular clamps are placed across the inferior vena cava above the cannula, and the inferior vena cava is divided between them (dashed line).
The Annals of Thoracic Surgery  , DOI: ( /S (98)00928-X)

5. Fig 4
The cardiac end of the divided inferior vena cava has been oversewn, and the inferior vena cava to conduit anastomosis is being performed with continuous polypropylene suture.
The Annals of Thoracic Surgery  , DOI: ( /S (98)00928-X)