Steps of surgery:
The child underwent surgery through mid-sternotomy employing
cardio-pulmonary bypass (CPB) under general anaesthesia. After
sternotomy, the thymus was excised completely to expose and loop the
innominate vein. That exposed the right carotid artery and left carotid
artery on either side of the trachea. This was followed by further
diligent dissection into the uppermost aspect of the posterior
mediastinum between the trachea, left carotid artery and ascending aorta
to trace entire length of the ASA and loop it so as to complete the
mobilisation (Figure 2A).
After establishing the cardio-pulmonary bypass (CPB), the ductus was
divided and sutured. Under mild hypothermia, the ASA was mobilised
proximally as well as distally and was transected near its aortic origin
while the subclavian end was brought anteriorly and was anastomosed with
the left carotid artery in an end to side fashion using 7/0 prolene
continuous sutures (Figure 2C). The removal of clamps revealed good
pulsatile flow with satisfactory distention of the ASA.
Thereafter, under cardioplegic arrest, the VSD (autologus pretreated
pericardial patch) and ASD (direct closure) were closed from right
atrium. Patient was rewarmed and cross clamp was released. All the steps
of open-heart surgery were along the standard lines. Child was
discharged on the seventh day with good pulsations of the left radial
artery. The child remains symptom-free and has well felt pulsations in
left radial artery 3 months after surgery.