Modified Yasui Operation With Cryopreserved Femoral Vein Homograft For Correction Of Type-b Interrupted Aortic Arch With Ventricular Septal Defect And Aberrant Right Subclavian Artery.
Manan Desai, Karthik Vaidyanathan Ramakrishnan, Richard Jonas.
Children's National Medical Center, Washington, DC, USA.
Objective(s): To demonstrate the surgical technique of a modified Yasui operation for type B interrupted aortic arch, ventricular septal defect and aberrant right subclavian artery with the use of cryopreserved femoral vein homograft.
Methods: Through a median sternotomy, cardiopulmonary bypass is initiated and the ductus arteriosus is ligated. The ductus arteriosus is transected from the descending aorta. The main pulmonary artery is transected just proximal to the bifurcation. An appropriately sized non-valved segment of a cryopreserved femoral vein homograft is anastomosed to the end of the divided descending aorta. The other end of the homograft is anastamosed to the stump of the divided main pulmonary artery. A side-to-side anastomosis is then performed between the femoral vein homograft and the ascending aorta. Cardioplegia is then administered and the ventricular septal defect is closed through a right ventriculotomy, baffling the left ventricle to the pulmonary artery (Figure 1a). The atrial septal defect, if present, is closed at this time. The operation is completed by reconstructing the right ventricular outflow tract using a valved femoral vein homograft conduit between the right ventricle and the pulmonary artery bifurcation (Figure 1b). Results: 3 neonates have been operated with this technique so far with no mortality.
Conclusions: This technique avoids distortion of the great vessels, is reproducible and is an effective alternative to the classical Yasui procedure.
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