The Neonatal Arterial Switch Operation: How I Teach It

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The Neonatal Arterial Switch Operation: How I Teach It Charles D. Fraser, MD The Annals of Thoracic Surgery Volume 102, Issue 3, Pages 681-684 (September 2016) DOI: 10.1016/j.athoracsur.2016.07.047 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Coronary ostial translocation. (A) Site of left and right coronary arteries to be used in translocation above the sinotubular junction. (B) Small transverse aortotomy. (C) Clear and careful visualization of the coronary ostia. (D) Generous resection of the coronary ostial buttons down to the reflection point of the aortic valve. (E) Coronary buttons will be placed where they are not subject to axial torsion. (Ao = aorta; LCA = left coronary artery; PA = pulmonary artery; RCA = right coronary artery.) (Printed with permission from Texas Children’s Hospital.) The Annals of Thoracic Surgery 2016 102, 681-684DOI: (10.1016/j.athoracsur.2016.07.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Stepwise illustration of the arterial switch operation. (A) D-transposition of the great arteries. (B) Aortic cross-clamp to initiate cardiopulmonary bypass. (C) Transection of the ascending aorta and main pulmonary artery. (D) Visualization of the left and right coronary ostia. (E) Excision of the left and right coronary buttons from the aortic root with adjacent aortic wall as coronary artery buttons. (F) Coronary buttons are surgically implanted into the sinus facing the main pulmonary artery root. (G) The distal aorta is anastomosed to the neoaortic root. (H) Patch reconstruction of the main pulmonary artery using pulmonary artery homograft. (I) LeCompte maneuver. (J) Completion of the arterial switch operation with closure of the atrial septal defect and confirmation by echocardiography. (Ao = aorta; Cx = circumflex artery; IVC = inferior vena cava; LA = left atrium; LAD = left anterior descending artery; LV = left ventricle; PA = pulmonary artery; RA = right atrium; RCA = right coronary artery; RV = right ventricle; SVC = superior vena cava.) (Printed with permission from Texas Children’s Hospital.) The Annals of Thoracic Surgery 2016 102, 681-684DOI: (10.1016/j.athoracsur.2016.07.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions