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Bader et al. Vessel Plus 2020;4:34 I http://dx.doi.org/10.20517/2574-1209.2020.36 Page 11 of 14

Figure 8. Sketch demonstrating the aortic uncrossing procedure with reimplantation (with patch augmentation) of the retroesophagal
arch anteriorly on the left side of the ascending aorta. The head and neck vessels are: left common carotid artery (LCCA), right common
carotid artery (RCCA), right subclavian artery (RSCA) and the aberrant left subclavian artery (ALSCA)

Figure 9. Computed tomography scan of a neonate with circumflex aorta with left aortic arch and critical arch hypoplasia: (left)
descending aorta location to the right side of the spine; (middle) normalization of the course of the descending aorta following posterior
aortic translocation; (right) 3D reconstruction of the aortic arch following surgery

uncrossing procedure has also been used in single ventricular physiology with aortic arch obstruction
[34]
requiring a concomitant Norwood procedure .

Circumflex aorta with hypoplastic left arch: a rare variant of obstructed circumflex aorta. Resection of a
long hypoplastic segment, posterior aortic translocation, division of the arterial ligament, and extended
[7]
end to end repair of the arch has been described . These surgical strategies addressed all the associated
pathophysiological mechanisms of circumflex aorta with hypoplastic arch: (1) relief of vascular ring; (2)
removal of posterior arch compression on the trachea; and (3) correction of any arch obstruction. If the
proximal arch (between innominate and left common carotid artery) is adequate, the procedure can be
performed off-pump from the left chest.