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• W3087936384 abstract "Central MessageAortic translocation for circumflex aorta causing tracheobronchial compression can be performed safely on a beating heart using normothermic cardiopulmonary bypass via dual arterial cannulation.See Commentary on page 243. Aortic translocation for circumflex aorta causing tracheobronchial compression can be performed safely on a beating heart using normothermic cardiopulmonary bypass via dual arterial cannulation. See Commentary on page 243. The first description of aortic uncrossing was in 1984 by Planché and LaCoeur-Gayet.1Planché C. LaCoeur-Gayet F. Aortic uncrossing for compressive circumflex aorta: 3 cases.Press Med. 1984; 13: 1331-1332PubMed Google Scholar This procedure allows translocation of the retroesophageal aorta (Figure 1, A and B) anterior to the trachea (Figure 1, C and D), thus alleviating the airway compression. The aortic arch then changes from being right sided to a left sided, relative to the airway. We present the technique in a 7-month-old girl with a vascular ring consisting of a right aortic arch with mirror-image branching and a left-sided descending aorta and left ligamentum, using normothermic cardiopulmonary bypass (CPB) (Figure 2).Figure 2Illustration showing the anatomy of the aortic arch in the current case. Right aortic arch with retroesophageal circumflex aorta. The order of branching are left common carotid, followed by right common carotid, right subclavian, and left subclavian arteries. Trachea and esophagus are encircled between the left ligamentum, right arch, and retroesophageal circumflex aorta.View Large Image Figure ViewerDownload (PPT) Intraoperative bronchoscopy was performed to evaluate the airway (Figure 3, A). After sternotomy and adequate mobilization of ascending aorta, arch and branches, CPB was initiated via dual arterial cannulation (right common carotid and descending aorta) at normothermia. Left ligamentum arteriosum was divided. A side-biting clamp was placed on the proximal descending aorta, and another 1 just after the takeoff of the right subclavian artery. The proximal arch was then transected and the proximal end was over sewn. The arch was then brought from its retroesophageal position anteriorly where it was anastomosed in an end-to-side fashion to the distal ascending aorta (Figure 4). Clamps were removed and the patient was weaned off CPB. Repeat bronchoscopy showed complete relief of airway compression (Figure 3, B). The patient was extubated in the operating room and the postoperative course was uneventful. Permission from the parents to publish this case was obtained.Figure 3A and B, Intraoperative bronchoscopy before (A) and after (B) the uncrossing procedure showing complete relief of the tracheobronchial compression.View Large Image Figure ViewerDownload (PPT)Figure 4Illustration showing the postoperative result after the uncrossing procedure where the right arch simply becomes a left arch.View Large Image Figure ViewerDownload (PPT)Figure 5Dual arterial cannulation in infants is a useful technique to avoid circulatory arrest.View Large Image Figure ViewerDownload (PPT) Circumflex aorta should be addressed when present with other vascular ring variants to avoid recurrence of symptoms and repeat operation.2Backer C.L. Mongé M.C. Russell H.M. Popescu A.R. Rastatter J.C. Costello J.M. Reoperation after vascular ring repair.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2014; 17: 48-55Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The procedure can be performed safely on a beating heart without circulatory/cardioplegic arrest3Binsalamah Z.M. Chacon-Portillo M.A. Sanyahumbi A. Adachi I. Heinle J.S. Fraser Jr., C.D. et al.Circumflex aorta with double aortic arch in an infant.J Card Surg. 2018; 33: 292-295Crossref PubMed Scopus (1) Google Scholar using the technique of dual arterial cannulation (Figure 5).4Kreuzer M. Sames-Dolzer E. Benedikt P. Mair R. Mair R. Double-arterial cannulation during aortic arch reconstruction in pediatric patients.Multimed Man Cardiothorac Surg. 2018; 17: 2018Google Scholar We used the same size cannula for both upper and lower body perfusion, leaving it up to each organ's vascular resistance to regulate its own blood flow. We did not feel the need for concomitant tracheobronchopexy due to the complete resolution of airway compression.5Kamran A. Friedman K.G. Jennings R.W. Baird C.W. Aortic uncrossing and tracheobronchopexy corrects tracheal compression and tracheobronchomalacia associated with circumflex aortic arch.J Thorac Cardiovasc Surg Tech. 2020; 3: 796-804Abstract Full Text Full Text PDF Scopus (10) Google Scholar https://www.jtcvstechniques.org/cms/asset/f713e20c-16f7-4580-8c8f-571cec907eb2/mmc1.mp4Loading ... Download .mp4 (199.88 MB) Help with .mp4 files Video 1This video demonstrates the surgical technique of aortic uncrossing in a 7-month-old infant who had severe tracheobronchial compression due to circumflex aorta. The procedure was performed on beating heart at normothermia with complete relief of airway compression. Video available at: https://www.jtcvs.org/article/S2666-2507(20)30525-3/fulltext." @default.
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• W3087936384 date "2020-12-01" @default.
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• W3087936384 title "Aortic uncrossing procedure: When the right becomes left" @default.
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• W3087936384 doi "https://doi.org/10.1016/j.xjtc.2020.09.017" @default.
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