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Modified Norwood Procedure for Tricuspid Atresia, Transposition of Great Arteries, and Hypoplastic Right Arch With Complete Vascular Ring  Chan-Yang Hsu,

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Presentation on theme: "Modified Norwood Procedure for Tricuspid Atresia, Transposition of Great Arteries, and Hypoplastic Right Arch With Complete Vascular Ring  Chan-Yang Hsu,"— Presentation transcript:

1 Modified Norwood Procedure for Tricuspid Atresia, Transposition of Great Arteries, and Hypoplastic Right Arch With Complete Vascular Ring  Chan-Yang Hsu, MD, Jin-Chung Shih, MD, PhD, Shyh-Jye Chen, MD, PhD, En-Ting Wu, MD, PhD, Chun-Wei Lu, MD, Yih-Sharng Chen, MD, PhD, Shu-Chien Huang, MD, PhD  The Annals of Thoracic Surgery  Volume 102, Issue 5, Pages e481-e483 (November 2016) DOI: /j.athoracsur Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) The 3D CT showed rudimentary RV and the main LV was shown. The great arteries were side-by-side, and the left coronary artery traveled in front of the main pulmonary artery. (B) The trachea is encircled by the vascular ring. (aLSCA = aberrant left subclavian artery; AsAo = ascending aorta; KD = Kommerell’s diverticulum; LCCA = left common carotid artery; LV = left ventricle; MPA = main pulmonary artery; PDA = patent ductus arteriosus; RCCA = right common carotid artery; RSCA = right subclavian artery; RV = right ventricle; T = trachea.) The Annals of Thoracic Surgery  , e481-e483DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 The schematic drawing of operation. (A) The cannulation site and direction were shown, after dual arterial cannulation (both 8Fr); the distal right arch was transected as the red dotted line and anastomosed to 3.5 mm Gore-Tex graft (arrow). (B) Asterisks show the clamp sites for selective brain perfusion during neo-aortic reconstruction. (C) The intra-operative photo during neo-aorta reconstruction. Neo-aorta reconstruction incorporating AsAo-LCCA, aLSCA, Kommerell’s diverticulum, and the MPA. (D) The 3.5 mm Gore-Tex graft then served as a Blalock-Taussig shunt, while the original right arch became a “neo” right innominate artery and the aberrant left subclavian artery became a “normal” left subclavian artery. (aLSCA = aberrant left subclavian artery; AsAo = ascending aorta; DsAo = descending aorta; KD = Kommerell’s diverticulum; LCCA = left common carotid artery; LPA = left pulmonary artery; LV = left ventricle; MPA = main pulmonary artery; PDA = patent ductus arteriosus; RCCA = right common carotid artery; RPA = right pulmonary artery; RSCA = right subclavian artery; RV = right ventricle; T = trachea.) The Annals of Thoracic Surgery  , e481-e483DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 From the posterior view, the 3D CT reconstruction image before (A) and 14 days after (B) the operation demonstrates the complete relief of the encircled trachea and the new aorta with left arch. (aLSCA = aberrant left subclavian artery; AsAo = ascending aorta; BT = Blalock-Taussig shunt; DsAo = descending aorta; KD = Kommerell’s diverticulum; LCCA = left common carotid artery; LSCA = left subclavian artery; MPA = main pulmonary artery; RCCA = right common carotid artery; RSCA = right subclavian artery.) The Annals of Thoracic Surgery  , e481-e483DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

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