Right-sided intrathoracic bypass graft for complex or recurrent coarctation of the aorta

A simple technique is described for the interposition of a tube graft between the ascending and descending aorta in the right chest. Directing the graft posteriorly preserves the integrity of the pericardium and avoids potential damage to the prosthesis at a subsequent sternotomy for open heart surgery. This procedure was used successfully and without complication in an 18-month-old boy who had undergone two previous operations for coarctation of the aorta, and in a 20-year-old girl with William's syndrome and diffuse hypoplasia of the distal aortic arch.