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[Subclavian Flap Angioplasty and the Reconstruction of the Distal Subclavian Artery for Recurrent Coarctation of the Thoracic Aorta through the Median Sternotomy].

The Procedure of the subclavian flap angioplasty and reimplantation of the distal subclavian artery into the left carotid artery was used in 2 infants( 4-month-old and 5-month-old) with recurrent coarctation of the thoracic aorta through the median sternotomy. After median sternotomy, the aortic arch and its branches were extensively dissected. The descending aorta was minimally dissected. An arterial cannula was inserted into the brachiocephalic artery and the cardiopulmonary bypass was started by bicaval cannulation. The aortic root cannula was inserted into the aortic root and T-connected with the side hole of the brachiocephalic arterial cannula. The 2 cases underwent surgery with selective cerebral and myocardial perfusion. The left subclavian artery was transected and the subclavian flap technique was used to enlarge the recoarctation of the thoracic aorta. Then, the distal end of the transected left subclavian artery was reconstructed by performing an end to side anastomosis to the left carotid artery. This procedure has several advantages;(1) minimal dissection of the descending aorta is required,(2) the use of prosthetic material is avoided, (3) it prevents ischemic arm complication, (4) additional skin incision is avoided.