An aortic purse string is placed on the very proximal pulmonary artery, just above the sinuses of Valsalva. A single venous purse string is placed around the right atrial appendage, one that is large enough to later enable atrial septectomy directly through the purse string. The left pulmonary artery is mobilized and snared down with a silk suture. The head is packed in ice, and once half-flows are achieved, the ventilator is turned off. The dissection The aorta, pulmonary artery, ductus arteriosus, the descending thoracic aorta, and head vessels are widely mobilized.
Dissection begins by mobilizing the aorta away from the pulmonary artery.
The first-assistant picks up the large pulmonary artery to retract against the diminutive aorta which is dissected away from the pulmonary artery using electrocautery. The aorta is dissected completely from its root to the head vessels. The head vessels will need to be completely mobilized. The innominate artery is dissected above the innominate vein, and both the right subclavian and right carotid arteries are mobilized and encircled with snares. The pulmonary artery and large arterial duct are dissected free.