Chimney Technique for Aortic Arch Repair in the Norwood Operation

Abstract

Aortic arch repair is an important technical element in the Norwood operation for hypoplastic left heart syndrome that could adversely affect long-term results. Therefore, there are many controversies surrounding this procedure. We developed an alternative chimney technique for aortic arch repair without any supplemental materials. Both pulmonary branch orifices were resected en bloc from the posterior wall of the pulmonary trunk. The pulmonary defect was closed by longitudinal direct anastomosis. Consequently, the neo-aortic trunk was completed as a gradually converged, chimney-like shape. The effective length of the neo-aortic trunk elongated longitudinally, and the caliber of the trunk was reduced transversely. The elongated neo-aortic trunk could be anastomosed directly to the aortic arch without excessive tension. The neo-aortic trunk was joined to the aortic arch with a gentle shape. A hydrodynamically advantageous aortic configuration was completed, and a large subaortic arch space was provided. Chimney technique is an innovative procedure in the Norwood operation that requires no supplemental material.