Complete augmentation of diffuse narrowing of the aorta with Williams syndrome by using an overturn approach Masaaki Yamagishi, MD, Keisuke Shuntoh,

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Complete augmentation of diffuse narrowing of the aorta with Williams syndrome by using an overturn approach Masaaki Yamagishi, MD, Keisuke Shuntoh, MD, Tsutomu Matsushita, MD, Katsuji Fujiwara, MD, Takeshi Shinkawa, MD, Takako Miyazaki, MD, Nobuo Kitamura, MD The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 6, Pages 1556-1558 (June 2003) DOI: 10.1016/S0022-5223(03)00008-4

Figure 1 Schematic representation of the operative procedure. A, Resected areas at the AAo and the origin of the neck arteries are indicated by the gray zone. B, Distal stumps of the neck arteries were unifocalized. The anterior wall of the DAo was incised longitudinally. C, The homograft was anastomosed to the unifocalized neck arteries in an end-to-end fashion. The DAo was augmented with another homograft patch. D, The AAo homograft was anastomosed to the proximal AAo stump. The cranial end of the DAo homograft was anastomosed to the left side wall of the AAo homograft in an end-to-side fashion. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1556-1558DOI: (10.1016/S0022-5223(03)00008-4)

Figure 2 Intraoperative findings. A, Findings after the caval veins, the right pulmonary artery, and the left atrial wall, including the right pulmonary venous orifices, were incised and then the heart was turned over leftward are shown. A wide-field of view of the posterior mediastinal space was opened. B, Posterior to the right bronchus, a homograft patch was anastomosed to the longitudinal incision of the DAo. The cranial end of the homograft was sewn in a roll shape (arrow). The asterisk indicates the AAo homograft. H, Homograft patch; IVC, inferior vena cava; LA, left atrium; RA, right atrium; RB, right bronchus; RPVs, right pulmonary veins; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1556-1558DOI: (10.1016/S0022-5223(03)00008-4)