PMC3351261_01
PMC3351261_02
PMC3351261_03
PMC3351261_04
Photograph and diagrammatic schema of the cannulation of the brachiocephalic trunk and double venae cavae for extracorporeal circulation (ECC). A tourniquet was placed in the left carotid, the left subclavian artery and the descending aorta. ECC was initiated, and the DA was ligated. A clamp was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation. The tourniquets were then closed. A flap was created in the semilunar section in the initial portion of the anterior pulmonary trunk 3 cm above the pulmonary valve. A second semilunar incision was made in the anterosuperior side of the arch of the aorta near the left carotid and left subclavian arteries, creating the second flap.
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The DA was ligated (Figure 1), and the ECC flow was temporarily reduced to 20 ml/kg/min. This modification created a flap of autologous tissue (Figure 1). A second semilunar incision was made in the anterosuperior side of the aortic arch near the left carotid and the left subclavian artery, creating a second flap of autologous tissue (Figure 1).
A photograph and diagrammatic schema of the introduction of a 5 mm catheter through the opening of the pulmonary trunk, toward the pulmonary arteries. We placed the pulmonary trunk cerclage around this catheter using cardiac tape sutured with 5-0 Prolene.
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This procedure resulted in a systemic pulmonary shunt with autologous tissue (Figure 2).
A photograph and diagrammatic schema. The aortic flap was rotated caudally, and the pulmonary trunk flap was rotated cranially. These flaps were sutured edge-to-edge with 7-0 Prolene, originating the autologous posterior wall of the neo-aorta.
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The free edges of the semilunar flaps of the aorta and pulmonary trunk were rotated and sutured edge-to-edge, originating the autologous posterior neo-aortic wall (Figure 3).
A photograph and diagrammatic schema. The implantation of a valved bovine pericardium patch from the anterior opening of the pulmonary trunk to the aortic arch, extending to the beginning of the descending aorta resulting the anterior wall of the neo-aorta.
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This procedure resulted in the anterior wall of the neo-aorta (Figure 4).
PMC3351261_05