Abstract：
The following video tutorial presents the surgical correction of the left circumflex aortic arch in a 6-month-old boy with severe respiratory distress and stridor. The diagnosis was confirmed using cardiac catheterization and computed tomography. Intraoperative bronchoscopy showed marked compression of the trachea. An operation was planned to translocate the aortic arch anteriorly and to close the atrial septal defect. After a median sternotomy, the mediastinal structures were carefully mobilized and dissected. The trachea was carefully mobilized and the right ligamentum arteriosum was clipped and divided. Control of the aortic arch vessels, as well as the aberrant right subclavian artery from the right descending aorta, was achieved using vessel loops. An arterial line inserted in the femoral artery was connected to the heart-lung machine. Hence the surgical procedure was undertaken in selective antegrade cerebral perfusion combined with distal body perfusion, avoiding the need for deep hypothermic arrest. Careful mobilization of the complete course of the proximal and distal sections of the circumflex arch allowed its translocation from its retro-oesophageal course. The aortic stump distal to the left subclavian artery was closed by running polypropylene suture. An appropriate site on the ascending aorta was selected to ensure tension- and torsion-free anastomoses. Postoperative bronchoscopy confirmed relief of the tracheal compression.
摘要：
以下视频教程介绍了一个6个月大的男孩的左旋主动脉弓的手术矫正，该男孩患有严重的呼吸窘迫和喘鸣。使用心脏导管插入术和计算机断层扫描证实了诊断。术中支气管镜检查显示气管明显受压。计划进行手术以将主动脉弓向前移位并闭合房间隔缺损。正中胸骨切开术后，纵隔结构被仔细地动员和解剖。小心地动员气管，并夹住并分开右动脉韧带。主动脉弓血管的控制，以及来自右降主动脉的异常右锁骨下动脉，是使用血管回路实现的。将插入股动脉的动脉管线连接到心肺机。因此，外科手术是在选择性顺行脑灌注结合远端身体灌注中进行的，避免深低温骤停的需要。仔细动员回旋弓的近端和远端部分的完整过程，可以使其从食道后移位。通过聚丙烯缝合线闭合左锁骨下动脉远端的主动脉残端。选择升主动脉上的适当部位以确保无张力和无扭转吻合。术后支气管镜检查证实气管压迫缓解。
