Beating-Heart Surgery for Hypoplastic Left Heart Syndrome With Coronary Artery Fistulas Shunsuke Matsushima, MD, Yoshihiro Oshima, MD, PhD, Ayako Maruo,

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Beating-Heart Surgery for Hypoplastic Left Heart Syndrome With Coronary Artery Fistulas Shunsuke Matsushima, MD, Yoshihiro Oshima, MD, PhD, Ayako Maruo, MD, PhD, Tomomi Hasegawa, MD, PhD, Hironori Matsuhisa, MD, PhD, Rei Noda, MD, Ryuma Iwaki, MD The Annals of Thoracic Surgery Volume 98, Issue 5, Pages e103-e105 (November 2014) DOI: 10.1016/j.athoracsur.2014.06.112 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative, color Doppler flow mapping echocardiograms. (A) Parasternal short-axis view showing extensive ventriculocoronary connections (white arrows). (B) Parasternal long-axis view showing prominent antegrade systolic flow in the ascending aorta (yellow arrow). (aAo = ascending aorta; LA = left atrium; LV = left ventricle; RV = right ventricle.) The Annals of Thoracic Surgery 2014 98, e103-e105DOI: (10.1016/j.athoracsur.2014.06.112) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schematic diagram of the beating-heart Norwood procedure. Continuous coronary perfusion was maintained through an 18-gauge cardioplegia spike (CP spike). The lesser curvature of the newly reconstructed aortic arch was augmented with a glutaraldehyde-treated, autologous pericardial patch (black arrow) joining the main pulmonary artery (PA) to the descending aorta (dAo). This amalgamation was anastomosed to the longitudinally opened aortic arch. (aAo = ascending aorta; BCA = brachiocephalic artery; ePTFE = expanded polytetrafluoroethylene; LCA = left common carotid artery; LSCA = left subclavian artery.) The Annals of Thoracic Surgery 2014 98, e103-e105DOI: (10.1016/j.athoracsur.2014.06.112) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions