Augmentation of the Lesser Curvature With an Autologous Vascular Patch in Complex Aortic Coarctation and Interruption Heemoon Lee, MD, Ji-Hyuk Yang,

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Augmentation of the Lesser Curvature With an Autologous Vascular Patch in Complex Aortic Coarctation and Interruption Heemoon Lee, MD, Ji-Hyuk Yang, MD, PhD, Tae-Gook Jun, MD, PhD, Yang Hyun Cho, MD, PhD, I-Seok Kang, MD, June Huh, MD, PhD, Jinyoung Song, MD, PhD The Annals of Thoracic Surgery Volume 101, Issue 6, Pages 2309-2314 (June 2016) DOI: 10.1016/j.athoracsur.2016.01.017 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Illustrations show our initial technique for coarctation with arch hypoplasia. The aortic arch is augmented at the lesser curvature with a patch derived from the isthmus during resection and extended end-to-end anastomosis. The Annals of Thoracic Surgery 2016 101, 2309-2314DOI: (10.1016/j.athoracsur.2016.01.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Illustrations show our modified technique for coarctation with arch hypoplasia. After an L-shape trapdoor incision on the proximal arch, the patch is located anteriorly compared with the initial technique. This facilitates easier anastomosis and hemostasis. The Annals of Thoracic Surgery 2016 101, 2309-2314DOI: (10.1016/j.athoracsur.2016.01.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Illustrations show our modified technique for type A interrupted aortic arch. A generous amount of patch material can be harvested from the pulmonary artery, which is repaired with autologous pericardium. The Annals of Thoracic Surgery 2016 101, 2309-2314DOI: (10.1016/j.athoracsur.2016.01.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Suprasternal notch view of transthoracic echocardiography shows the entire aortic arch. Transverse diameter of the aortic arch (T) was defined as the maximal horizontal distance between the midpoints of the ascending and descending aorta, passing through the axial plane of the right pulmonary artery. Height of the aortic arch (A) was defined as the maximal vertical distance between T and the highest midpoint of the aortic arch. The Annals of Thoracic Surgery 2016 101, 2309-2314DOI: (10.1016/j.athoracsur.2016.01.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The heart and great vessels are seen in three-dimensional reconstructions of posterior view computed tomography (CT) images. (A) Preoperative CT image shows coarctation with arch hypoplasia (*). (B) Postoperative CT image shows the natural shape of the arch after augmentation of the lesser curvature. The Annals of Thoracic Surgery 2016 101, 2309-2314DOI: (10.1016/j.athoracsur.2016.01.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions