Techniques of Reconstruction for Inadequate Donor Left Atrial Cuff in Lung Transplantation Takahiro Oto, MD, Marc Rabinov, Justin Negri, Silvana Marasco,

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Techniques of Reconstruction for Inadequate Donor Left Atrial Cuff in Lung Transplantation Takahiro Oto, MD, Marc Rabinov, Justin Negri, Silvana Marasco, Michael Rowland, Adrian Pick, Gregory Snell, Franklin Rosenfeldt, Donald Esmore The Annals of Thoracic Surgery Volume 81, Issue 4, Pages 1199-1204 (April 2006) DOI: 10.1016/j.athoracsur.2005.11.057 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Reconstruction techniques for an inadequate left atrial cuff. (A) For a short length of the left atrial cuff limited in its anterior wall, a partial patch repair with donor pericardium was performed. (B) For a short length of the left atrial cuff seen both in its anterior and posterior wall, a donor pericardial patch repair for both the anterior and posterior walls was performed. (C) For separated superior and inferior pulmonary veins, the two separated veins were directly sutured back together with a wide septum to create an oval cross-sectional cuff. (D) For separated superior and inferior pulmonary veins that were too short to be directly sutured back together, the divided edges of the two veins were sutured with pericardium around each of the vein orifices, and a new cuff was created. (E) When the inferior pulmonary vein was discontinued at the level of a segmental branch, a cylinder of donor pulmonary artery was used as a conduit between segmental veins that had been sutured back together. This cylinder was sutured to the superior pulmonary vein to create a new atrial cuff. The Annals of Thoracic Surgery 2006 81, 1199-1204DOI: (10.1016/j.athoracsur.2005.11.057) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Operative photographs (top panels) and corresponding line diagrams (bottom panels) showing the technique for reconstructing a new left atrial cuff using a segment of donor pulmonary artery as a conduit. The Annals of Thoracic Surgery 2006 81, 1199-1204DOI: (10.1016/j.athoracsur.2005.11.057) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions