The aortic uncrossing procedure

Recurrent Pediatric Respiratory Distress From a Challenging Vascular Anomaly

“… 1 Importantly, among these patients, ligamentum division alone often does not adequately relieve the posterior and right-sided tracheal compression caused by the transverse aorta and RAA, respectively. 2 , 3 Moreover, an unsuccessful prior vascular ring division or aortopexy may increase the complexity of the subsequent uncrossing procedure. 3 …”

“… 2 , 3 Moreover, an unsuccessful prior vascular ring division or aortopexy may increase the complexity of the subsequent uncrossing procedure. 3 …”

“… 2 First, marking sutures placed on the left lateral side of the ascending aorta at the site of the proposed implantation before the initiation of cardiopulmonary bypass (ie, with the heart distended) may facilitate aortic uncrossing later in the operation. 1 , 3 Second, during dissection of the RAA to delineate the site of aortic transection distal to the right subclavian artery, caution must be exercised to avoid injury to the right recurrent laryngeal nerve (RLN). Similarly, during dissection of the descending aorta from its posterior attachments, great care must be taken in the region of the left RLN.…”

“…Furthermore, there should be sufficient room for the right pulmonary artery to traverse anterior to the trachea and posterior to the ascending aorta and transverse arch. 2 , 3 Persistent obstructive respiratory symptoms after the uncrossing operation mandates a detailed bronchoscopic evaluation of the membranous trachea.…”

Aortic Uncrossing for Circumflex Aorta

“…Other studies have also reported similar results of the aortic uncrossing procedure. 4,7,8 Currently, both patients are asymptomatic at six months and three months, respectively, after the surgery. Although the aortic uncrossing procedure provides total anatomical correction, it requires hypothermic circulatory arrest.…”