Serban C. Stoica, MD, Alistair B

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The Retrograde Aortic Arch in the Hybrid Approach to Hypoplastic Left Heart Syndrome Serban C. Stoica, MD, Alistair B. Philips, MD, Matthew Egan, MD, Roberta Rodeman, RN, Joanne Chisolm, RN, Sharon Hill, ACNP, John P. Cheatham, MD, Mark E. Galantowicz, MD The Annals of Thoracic Surgery Volume 88, Issue 6, Pages 1939-1947 (December 2009) DOI: 10.1016/j.athoracsur.2009.06.115 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Angiographic appearance of retrograde aortic arch obstruction in an interstage patient found to have tricuspid regurgitation, decreased right ventricular function, and a 35-mm Hg gradient across the aortic arch. (B, C, and D) Same patient treated with an 8-mm-long coronary stent expanded to 5 mm. Gradient disappeared and right ventricular function and tricuspid regurgitation returned to baseline. The Annals of Thoracic Surgery 2009 88, 1939-1947DOI: (10.1016/j.athoracsur.2009.06.115) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Patient flow chart. The Annals of Thoracic Surgery 2009 88, 1939-1947DOI: (10.1016/j.athoracsur.2009.06.115) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier survival curves for groups 1 and 2. (A) Survival to stage 2; p = 0.005. (B) Survival overall; p = 0.03. The Annals of Thoracic Surgery 2009 88, 1939-1947DOI: (10.1016/j.athoracsur.2009.06.115) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Autopsy specimen showing congenital retrograde aortic arch obstruction (RAAO). (PDA = persistent ductus arteriosus.) The Annals of Thoracic Surgery 2009 88, 1939-1947DOI: (10.1016/j.athoracsur.2009.06.115) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Two-dimensional (left) and color Doppler echocardiograms (right) of retrograde aortic arch obstruction (A) and normal arch anatomy (B). The Annals of Thoracic Surgery 2009 88, 1939-1947DOI: (10.1016/j.athoracsur.2009.06.115) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions