Staged biventricular repair in aortic hypoplasia: the value of intraoperative myocardial perfusion.

The patient had a hypoplastic aortic arch with coarctation, a right aberrant subclavian artery, a bicuspid aortic valve, a ventricular septal defect and severe long-segment left ventricular outflow tract obstruction. The patient underwent initial univentricular palliation with subsequent biventricular conversion. Initially the patient had a Norwood operation with a Sano conduit at 23 days of age. The operation was performed on a beating heart with full-body perfusion for optimal preservation of heart cardiac function. At 9 months of age, the patient had a biventricular conversion that required ventricular septal defect enlargement and placement of the valve conduit from the right ventricle to the pulmonary artery (i.e. the Yasui procedure). The patient also had recurrent coarctation and left pulmonary artery stenosis; both were repaired with the heart beating to minimize myocardial ischaemic time.