Osman O. Al-Radi, MBBCh, MSC, FRCSC

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Presentation transcript:

Aortic ring autograft for reconstruction of the neo-pulmonary root in the arterial switch operation Osman O. Al-Radi, MBBCh, MSC, FRCSC The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 6, Pages e89-e91 (June 2016) DOI: 10.1016/j.jtcvs.2015.12.054 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Cannulation of the ascending aorta is done as distally as possible, and the patent ductus arteriosus is ligated and divided. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The aorta is transected 2 mm above the sinotubular junction. The pulmonary artery is transected below the branching point. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 The coronary arteries are separated from the aortic root as pear-shaped or round pedicles. The LeCompte maneuver is completed, and the aortic clamp is repositioned as high as possible. A ring of aorta is harvested and placed in cold saline. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The aortic ring autograft is cut at its widest point (right), creating a bowtie-shaped autograft (middle), which is used as a single patch to reconstruct the posterior sinuses of the neo-pulmonary root (left). Alternatively, the autograft is further divided into 2 patches, to repair each sinus separately. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Photograph of the bowtie-shaped ring aortic autograft used to reconstruct the posterior sinuses of the neo-pulmonary root. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 The completed repair showing the near anatomical placement of the coronary arteries and the shorter, more-posterior aorta, with minimal stretching of the pulmonary arteries. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

The cut aortic ring autograft is used to reconstruct the sinuses of the neo-pulmonary root. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e89-e91DOI: (10.1016/j.jtcvs.2015.12.054) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions