How I Do It - Yasui Procedure With Aberrant Right Subclavian Artery Translocation
Alan O'Donnell, James Tweddell, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective(s): Describe technique of the Yasui with relocation of an aberrant right subclavian artery (aRSCA) in 2m/o with aortic atresia, coarctation, perimembranous VSD, and bilateral SVC palliated with branch PAB and PGE.
Methods: There was an undiagnosed aRSCA from the descending aorta. The right carotid artery (RCA) was anastomosed to a graft distal enough to reimplant the aRSCA. The aRSCA was ligated at its origin and divided distal to ligature. It was mobilized from behind the esophagus and relocated anteriorly. The proximal RCA was incised longitudinally and the aRSCA was anastomosed in an end-to-side fashion. The descending aorta was mobilized, first three sets of intercostal branches taken. Incision completed from divided ductus and continued along underside of aortic arch and lateral ascending aorta. Cutback made to the left of facing pulmonary root commissure. DKS was performed. Edge of thoracic aorta and left lateral ascending aorta were joined together. Anterior arch reconstructed with pulmonary homograft. Ventriculotomy in RV free wall and enlarged to 15mm. VSD was enlarged superiorly and anteriorly. Pledget-supported sutures placed along inferior rim avoiding injury to tricuspid valve and conduction system. Ends of row were run continuously to complete baffle.RVOT was reconstructed with pulmonary homograft with proximal anterior hood. TEE showed normal function, no residual VSD. There was trivial AVV regurgitation. There was no LVOTO or RVOTO.
Conclusions: The Yasui Procedure and primary reimplantation of an aRSCA is a suitable strategy for this type of patient and an experienced surgeon.
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