Anterior Translocation Of Left Circumflex Aorta
Mina Farag, MD, Grieshaber Phillippe, Charlotte Steeg, Elizabeth Fonseca, Matthias Gorenflo, Matthias Karck, MD, PhD, Tsvetomir Loukanov, MD, PhD.
Heidelberg University, Heidelberg, Germany.
Objective(s): Left circumflex arch to right descending aorta can cause tracheobronchial compression leading to hypoxia and respiratory distress. Anterior translocation of the aorta to the same side, relieves obstruction. The herein presented technique depicts translocation operation in a 6-months-year old boy with a complete vascular ring formed by the right sided ligamentum and aberrant right subclavian artery. Methods: Intraoperative bronchoscopy confirmed the stenosis. Median sternotomy and extensive mobilization of the aorta as well as the supra-aortic vessels were performed. Cardiopulmonary bypass connection was achieved via dual arterial cannulation through right common carotid, as well as percutaneous femoral artery under moderate hypothermia (28°C). The right ligamentum arteriosum was divided. Control over the aorta as well as supra-aortic branches was obtained via vessel loops and vascular clamps. Additional atrial septal defect was closed using autologous pericardium. The aortic arch was transected just distal to the left subclavian artery. Anterior translocation was performed, and an end-to-side anastomosis with the distal ascending aorta was fashioned during continuous regional perfusion. Results: Repeat bronchoscopy showed marked relief of tracheal compression. Invasively measured pressures in the aorta and distal limb showed no pressure gradient. Respiratory weaning was possible on the 8th postoperative day and discharge into assisted care facility was possible on POD 31. Conclusions: Translocation of circumflex aortic arch alleviates tracheal compression. Dual arterial cannulation provides excellent exposure avoiding deep hypothermic circulatory arrest improving visceral organ protection.
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