Steps of surgery:
The child underwent surgery through mid-sternotomy employing cardio-pulmonary bypass (CPB) under general anaesthesia. After sternotomy, the thymus was excised completely to expose and loop the innominate vein. That exposed the right carotid artery and left carotid artery on either side of the trachea. This was followed by further diligent dissection into the uppermost aspect of the posterior mediastinum between the trachea, left carotid artery and ascending aorta to trace entire length of the ASA and loop it so as to complete the mobilisation (Figure 2A).
After establishing the cardio-pulmonary bypass (CPB), the ductus was divided and sutured. Under mild hypothermia, the ASA was mobilised proximally as well as distally and was transected near its aortic origin while the subclavian end was brought anteriorly and was anastomosed with the left carotid artery in an end to side fashion using 7/0 prolene continuous sutures (Figure 2C). The removal of clamps revealed good pulsatile flow with satisfactory distention of the ASA.
Thereafter, under cardioplegic arrest, the VSD (autologus pretreated pericardial patch) and ASD (direct closure) were closed from right atrium. Patient was rewarmed and cross clamp was released. All the steps of open-heart surgery were along the standard lines. Child was discharged on the seventh day with good pulsations of the left radial artery. The child remains symptom-free and has well felt pulsations in left radial artery 3 months after surgery.