Fontan conduit puncture in a patient with extracardiac conduit Fontan circulation made of Goretex. (A) Fontan conduit angiography. (B) Fluoroscopic image obtained while performing conduit puncture with a Brockenbrough needle and holding the dilator tip with a snare. (C) Intracardiac echocardiography of the conduit puncture. (D) The Brockenbrough needle and the Swartz introducer with the dilator tip held with a snare to prevent its sliding along the conduit wall. A, atrium; F, Fontan conduit; ICE, intracardiac echocardiography; LPA, left pulmonary artery; V, ventricle; θ, angle between the Fontan conduit wall and vertical line.