CLINICS 2012;67(5):521-524 New technique for HLHS correction Rocha-e-Silva R Figure 3 - A) The pulmonary trunk (PT) was represented using an 18-mm pericardial tunnel. A second 12-mm pericardial tunnel is placed on its posterior superior face to simulate the pulmonary branches. An additional 18-mm pericardium tube, which simulated the aortic arch (Ao), is then placed on the cranial face of the pulmonary trunk. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus (DA). B) The DA is ligated, and the autologous flaps were obtained through the semilunar opening of the aorta and pulmonary trunk. autologous posterior wall of the neo-aorta. There was no tension in this suture, and no mobilization of the aortic arch was required (Figure 4B). The anterior wall of the neo-aorta was created using a bovine pericardium patch sutured with prolene 6-0 (Figure 5). The valved patch was not used in this model, although the location of the valve position is shown in Figure 4B. The black dashed line indicates where the valve suture would be inserted into the pericardial patch that forms the anterior wall of the neo-aorta. EXPECTED RESULTS The construction of an experimental model used to demonstrate the novel technique for the correction of HLHS proved to be simple. The proposed procedure requires fewer sutures, which excludes the need to implant a heterologous systemic pulmonary shunt and decreases the surgical time. One patient who met the relevant criteria and required surgical correction was submitted to the procedure (15) and demonstrated that it could potentially reduce the perio- perative complications. The technique described does not require any period of coronary ischemia or surgical manipulation of the ven- tricle, as described previously (15). The combined effect of these improvements should promote a higher quality of postoperative ventricular function. Moreover, mainte- nance of the anatomy of the ascending aorta simplifies the procedure and avoids distortions in the coronary arteries. The in situ autologous systemic pulmonary shunt is simple to manufacture and should not generate thrombosis- related complications. In addition, the maintenance of the pulmonary trunk in situ (with the cerclage) should promote better development of the pulmonary tree. Figure 4 - A) Through the opening of the pulmonary trunk, a 5-mm catheter is introduced towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape with 5-0 prolene around the catheter. B) The aortic flap is rotated caudally, and the pulmonary trunk flap is rotated cranially. These flaps are then sutured edge-to-edge with 6-0 prolene originating the autologous posterior neo-aortic wall. The red marks indicate where the top of the valve of the pericardium should be placed. 523