**2. Surgical technique**

All patients were operated through a median sternotomy with extracorporeal circulation and moderate hypothermia. We used two techniques of total cavopulmonary anastomosis, according to anatomical characteristics of each patient. The technique I corresponds to the construction of an intracardiac lateral tunnel constructed with a patch of polytetrafluoroethylene (PTFE) sutured to the lateral aspect of the right atrium, thereby building a tunnel that diverts intracardiac blood from the inferior cava to the right pulmonary artery, thus completing total cavo-pulmonary connection. For these patients we routinely use aortic clamping and cardioplegia with blood. The technique II is interposition of a PTFE tube between the transected inferior cava and pulmonary artery, ipsilateral to the inferior cava vein, also completing total cavo-pulmonary connection. This is known as extracardiac Fontan. Use of aortic clamping and cardioplegia is optional according to surgeon's preference. Both techniques are performed with almost routine fenestration of 4 to 5 mm. In the technique I, a circular punch incision in the PTFE patch is made, so to communicate intracardiac lateral tunnel with atrial mass receiving the pulmonary venous return. In technique II, the fenestration is created by a similar punch incision in the lateral PTFE inner tube and a similar incision on the lateral aspect of the right atrium, proceeding to be anastomosed both holes as Luther-lateral (7.8).
