this report. A newborn girl (weight: 2.3 kg; height: 48 cm) was referred to the authors' institution with desaturation few hours after birth. Transthoracic echocardiography examination established the diagnosis as situs solitis, atrioventricular concordance, ventriculoarterial discordance, dextro-transposition of the great arteries, ventricular septal defect, and an interrupted aortic arch distal to the left subclavian artery (type A). At about 66 hours after birth, the infant underwent arterial switch operation with ventricular septal defect closure and repair of the interrupted aortic arch on cardiopulmonary bypass with deep hypothermic circulatory arrest. The right innominate artery was cannulated for selective antegrade perfusion (10 mL/kg/min) to the brain during the aortic arch repair. Near infrared spectroscopy was used to monitor cerebral oximetry throughout the procedure. In addition, intraoperative transesophageal echocardiography with a microtransesophageal sector array probe (Philips S8-3t pediatric transesophageal transducer; Philips Healthcare, Andover, MA) compatible with a Philips iE33 ultrasound machine was performed to confirm and quantitate the cardiac lesions. Subsequently, the transesophageal echocardiography probe was retracted into the pharynx, and the neck vessels were located on both right and left side for adequacy of perfusion by antegrade cerebral perfusion. On the right side, both carotid artery and internal jugular vein could be visualized side by side with blood flows in opposite directions to each (Fig 1A; Video 1). On the left side, only venous blood flow was seen because the selective perfusion was unilateral and was achieved by right innominate artery cannulation (Fig 1B; Video 2). The venous flow on the left side confirmed the completeness of Circle of Willis and ruled out any malperfusion on the contralateral side to the antegrade cerebral perfusion.
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