1. Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure 
Harold M. Burkhart, MD, David A. Ashburn, MD, Igor E. Konstantinov, MD, PhD, Nilto C. De Oliviera, MD, Lee Benson, MD, William G. Williams, MD, Glen S. Van Arsdell, MD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 130, Issue 1, Pages (July 2005)
DOI: /j.jtcvs
Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
Classic technique. The arch anatomy is examined (A), the patent ductus arteriosus is ligated, and an incision is made across the coarctation (B). The aortic arch is reconstructed with a homograft patch (C). Ao, Aorta; LCA, left carotid artery; LSA, left subclavian artery; PA, pulmonary artery; PDA, patent ductus arteriosus; RCA, right carotid artery; RSA, right subclavian artery; SVC, superior vena cava.
The Journal of Thoracic and Cardiovascular Surgery  , 61-65DOI: ( /j.jtcvs )
Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
Autologous and interdigitating techniques. An incision is made across the coarctation (A), and the periductal area is completely excised. In the autologous technique (B and C) the arch is reconstructed by anastomosing the aortic arch, distal aorta, and main pulmonary artery together. In the interdigitating technique (B1 and C1) 2 longitudinal incisions are made in the anterior and posterior walls of the descending aorta (B1.a), and an extended end-to-end anastomosis is constructed between the distal aortic arch and the posterior descending aorta (B1). A homograft patch is then used to reconstruct the remainder of the arch (C1). Ao, Aorta; LCA, left carotid artery; LSA, left subclavian artery; PA, pulmonary artery; RCA, right carotid artery; RSA, right subclavian artery; SVC, superior vena cava.
The Journal of Thoracic and Cardiovascular Surgery  , 61-65DOI: ( /j.jtcvs )
Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions