1. Modification of the subclavian patch aortoplasty for repair of aortic coarctation in neonates and infants 
Bradley S Allen, MD, Ari O Halldorsson, MD, Mary Jane Barth, MD, Michel N Ilbawi, MD 
The Annals of Thoracic Surgery 
Volume 69, Issue 3, Pages (March 2000)
DOI: /S (99)

2. Fig 1
Discrete aortic coarctation in an infant with a small ductus arteriosus, seen through left thoracotomy exposure. The pleura has been dissected off the aorta and ligatures have been placed around the small ductus or ligamentum arteriosum and distal left subclavian artery. The dotted line indicates the planned aortic and left subclavian incision.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
(A) Vascular clamps have been placed on the aortic arch and descending aorta, and intercostal branches controlled. The aorta and left subclavian have been opened and the left subclavian artery divided just proximal to the ligature. (Note: The aortotomy is carried distally for sufficient length to be well outside the area of ductal tissue to help prevent recoarctation.) (B) Starting at the level of the coarctation, the anterior-medial wall of the descending aorta is sutured to the aortic isthmus in a transverse fashion using running 7-0 Prolene (Ethicon, Somerville, NJ) suture. (C) The completed plication. (Note: This maneuver widens the coarctation, shortens the isthmus, and pulls the aortotomy proximally, thus allowing for a tension-free anastomosis of the subclavian flap, even with a long aortotomy or short subclavian artery.) (D) If further shortening of the aorta is necessary to prevent flap tension, the opposite aortic wall is also sutured to the isthmus with another running Prolene suture.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

4. Fig 3
(A) The subclavian flap is sutured to the aorta in the standard fashion using running 7-0 Prolene (Ethicon, Somerville, NJ) suture. (B) At the level of the enlargement, the two sutures are tied and the remaining repair of the coarctation with the subclavian flap is finished.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )