New technique for HLHS correction Rocha-e-Silva R CLINICS 2012;67(5):521-524 Figure 1 - A) Cannulation of the brachiocephalic trunk (cannulation of femoral artery not showed in the figure) and double venae cavae for extracorporeal circulation (ECC). Placement of the tourniquet in the left carotid and left subclavian arteries and descending aorta. Subsequently, ECC is initiated, and the ductus arteriosus is ligated. A clamp is then placed at the aortic arch to isolate the ascending aorta and the brachiocephalic trunk from the systemic circulation. Next, the tourniquets are closed, and a semilunar section of the initial portion of the anterior pulmonary trunk (3 cm above the pulmonary valve) is used to create a flap. A second semilunar incision is made into the anterosuperior side of the aortic arch near the left carotid and left subclavian arteries to create a second flap. B) A 5-mm catheter is introduced through the opening of the pulmonary trunk towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape around the catheter with 5-0 prolene. flow). The neo-aorta does not require mobilization of the ascending aorta or the pulmonary trunk. 15. A small right atriotomy is performed for atrial septum resection. After the appropriate maneuvers are per- formed to remove air that may be present, the tourniquets are released for subsequent finalization of the ECC. 16. The remainder of the procedure is performed accord- ing to the conventional protocol. The procedure was simulated in an experimental mechanical model as described below. The model was constructed with bovine pericardium tissue (HP Bioprosthesis Ltda.). The pulmonary trunk was represented using an 18-mm pericardial tunnel. On its posterior superior face, a second 12-mm pericardial tunnel was placed to simulate the pulmonary branches. On the cranial face of the pulmonary trunk, an additional 18-mm pericardium tube was placed to simulate the aortic arch. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus. All anastomoses were performed with prolene 6-0 (Figure 3A). The ductus arteriosus was ligated. The semilunar open- ings of the aorta and pulmonary trunk used to form the autologous flaps (to construct the neo-aorta) were created as depicted in Figure 3B. A 5-mm catheter was introduced through the opening of the pulmonary trunk towards the pulmonary branches. The pulmonary trunk cerclage was obtained by suturing a cardiac tape around the catheter with 5-0 prolene (Figure 4A). Following the removal of the catheter, a 5- mm systemic pulmonary shunt of autologous tissue was created. The aortic flap was rotated caudally, and the pulmonary trunk flap was rotated cranially. These flaps were then sutured edge-to-edge with 6-0 prolene originating the Figure 2 - A) The free edges of the semilunar flaps of the aorta and pulmonary trunk are rotated and sutured edge-to-edge originating the autologous posterior neo-aortic wall. B) A valved bovine pericardium patch is implanted from the anterior opening of the pulmonary trunk to the aortic arch and extends to the beginning of the descending aorta to give rise to the anterior wall of the neo- aorta. 522