Use of Partial Cardiopulmonary Bypass for Coarctation Repair Through a Left Thoracotomy in Children Without Collaterals Carl L. Backer, MD, Robert D.

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Presentation transcript:

Use of Partial Cardiopulmonary Bypass for Coarctation Repair Through a Left Thoracotomy in Children Without Collaterals Carl L. Backer, MD, Robert D. Stewart, MD, Angela M. Kelle, BS, Constantine Mavroudis, MD The Annals of Thoracic Surgery Volume 82, Issue 3, Pages 964-972 (September 2006) DOI: 10.1016/j.athoracsur.2006.04.060 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Relationship of the child to the location of the extracorporeal circuit and the position of the venous and arterial cannulas. This pump positioning allows easy access for the surgeon and first assistant and keeps the cardiopulmonary bypass lines out of the visual field of the coarctation repair. The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Through a posterolateral thoracotomy incision the lung has been retracted anteriorly with a “Kirklin fence.” The aortic cannula is shown in position in the descending thoracic aorta distal to the site for the distal aortic vascular clamp. The coarctation site and aortic arch have been dissected. (PDA = patent ductus arteriosus.) The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The lung has now been retracted posteriorly (temporarily) and the pericardium opened posterior to the phrenic nerve. The left atrial (LA) appendage has been cannulated with the venous cannula. The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The patient is now on partial cardiopulmonary bypass. The proximal and distal vascular clamps have been applied. The ligamentum has been ligated and divided. The dotted lines indicate the extent of the coarctation resection. In this case two intercostal collateral vessels have been ligated and divided. The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The coarctation specimen has been excised. An oversized Hemashield interposition graft is being sutured in place. This graft is beveled appropriately at each end to provide an oblique anastomosis allowing for growth. The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 The completed interposition graft is shown. The cannulation sutures have been tied. The pleura will be closed over the interposition graft. The Annals of Thoracic Surgery 2006 82, 964-972DOI: (10.1016/j.athoracsur.2006.04.060) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions