Systemic Venous Rerouting Through the Coronary Sinus for ccTGA With Bilateral SVCs Satoshi Asada, MD, Masaaki Yamagishi, MD, PhD, Takako Miyazaki, MD,

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Systemic Venous Rerouting Through the Coronary Sinus for ccTGA With Bilateral SVCs Satoshi Asada, MD, Masaaki Yamagishi, MD, PhD, Takako Miyazaki, MD, PhD, Yoshinobu Maeda, MD, Satoshi Taniguchi, MD, Shuhei Fujita, MD, Hisayuki Hongu, MD, Hitoshi Yaku, MD, PhD The Annals of Thoracic Surgery Volume 104, Issue 5, Pages e393-e395 (November 2017) DOI: 10.1016/j.athoracsur.2017.06.022 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative and postoperative three-dimensional computed tomographic images, (A) Anterior view of preoperative images showing mesocardia and the presence of bilateral superior venae cavae. (B) Right lateral and (C) posterior preoperative systemic and pulmonary venous images. (D) Anterior postoperative images showing the reconstructed right ventricle–to–pulmonary artery conduit (RVPAC). (E) Anterior and (F) posterior postoperative venous images showing nicely rerouted venous pathways. (IVC = inferior vena cava; LSVC = left superior vena cava; MBTS = modified Blalock-Taussig shunt; mLV = morphologic left ventricle; mRV = morphologic right ventricle; MV = mitral valve; RSVC = right superior vena cava; TV = tricuspid valve.) The Annals of Thoracic Surgery 2017 104, e393-e395DOI: (10.1016/j.athoracsur.2017.06.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraatrial rerouting technique. (A) Right-sided atriotomy 15 mm above terminal sulcus. (B) The interatrial septum (IAS) flap is created by incising along the dotted line. Incision of anterior margin is extended to the junction with the coronary sinus (CS), and that of posterior margin is extended to the junction with posterior wall. (C) The IAS flap is laid down toward the CS (a to a′, b to b′) to cover the CS. (D) The transposed IAS flap is anastomosed with the right-sided atrial (RA) inner wall. (E) The CS roof is incised along the bold line parallel to the inferior margin of the CS. The left-sided posterior atrial wall is transposed vertically. (F) The CS roof flap is sutured with the anterior margin of the atrial septal defect (ASD) (c to c′). The inferior margin of the right-sided atriotomy is anastomosed with the IAS flap and the RA inner wall (dotted line). (G) The systemic venous pathway (dotted arrow) and the pulmonary venous pathway (solid arrow). (H) The superior and inferior margins of the right-sided atriotomy are anastomosed. (inf. = inferior; IVC = inferior vena cava; LSVC = left superior vena cava; MV = mitral valve; PV = pulmonary veins; RSVC = right superior vena cava; sup. = superior; TV = tricuspid valve.) The Annals of Thoracic Surgery 2017 104, e393-e395DOI: (10.1016/j.athoracsur.2017.06.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions