Vascular Ring Repair Using The Uncrossing Procedure With Sustained Total All-Region Perfusion Arjith Rathakrishnan, Margaret Greco, Dana Irrer, Joshua Hermsen, Petros V. Anagnostopoulos. University of Wisconsin-Madison, Madison, WI, USA.
Objective(s): Vascular ring with a right aortic arch and circumflex aorta repaired using the uncrossing procedure with sustained total all-region perfusion. Methods: Case Report Results: 12 m.o M presented with noisy breathing and dysphagia since birth. Evaluation revealed that he had a right aortic arch with mirror image branching, left ligamentum, and descending thoracic aorta coursing left to the spine in the posterior mediastinum creating a circumflex aorta. Sustained total all-region (STAR) perfusion technique was used with cardiopulmonary bypass using ascending aortic and right atrial cannulation. With the heart beating, the ligamentum was double ligated and divided. Then, an antegrade cardioplegia cannula was placed above the sinotubular junction. The aorta was transected distal to the takeoff of the right subclavian artery and oversewn. Then, the arch was delivered to the left of the esophagus and the trachea. A distal perfusion catheter was placed in the descending thoracic aorta and a Turek clamp was applied and distal perfusion was commenced. A clamp was placed above the sinotubular junction and blood was infused in the root. An opening was then made on the left side of the ascending aorta. During STAR perfusion, ST depression was observed and the heart was arrested. An end-to-side anastomosis was performed between the distal descending thoracic aorta and the left side of the ascending aorta with an anterior bovine pericardial patch augmentation. Conclusions: Here we describe the surgical approach of a vascular ring that was repaired using the uncrossing procedure with STAR perfusion.
