\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{RECOMMENDATIONS FOR SPIRAL PULMONARY ARTERIOPLASTY}



\author[1]{Reshma Biniwale}%
\affil[1]{University of California Los Angeles Department of Surgery}%


\vspace{-1em}



  
  \date{June 09, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
\textbf{Case Video Summary:} This video demonstrates the principle of
spiral PA plasty whereby the length of branch pulmonary arteries can be
increased simultaneous to the increase in diameter by using a patch that
is anastomosed spirally around the vessels.%
\end{abstract}%



\sloppy


\textbf{RECOMMENDATIONS FOR SPIRAL PULMONARY ARTERIOPLASTY}

Reshma Biniwale MD1

1: University of California at Los Angeles, Department of Surgery,
Division of Cardiac Surgery

\textbf{The author reports no Conflicts of interest}

\textbf{IACUC approved Tissue sharing protocol 7/31/2019}

\textbf{Funding is provided by the Rachel Cooper Foundation Congenital
Cardiac Research Fund}

\textbf{IRB approval N/A since it is an animal tissue study,}

\textbf{Consent statement N/A since it is an animal tissue study}

\textbf{Clinical trial registration is not applicable for our study.}

Corresponding author:

Reshma Biniwale MD

10833 Le Conte Avenue, Suite 62-266 CHS, Los Angeles CA 90095

Email: rbiniwale@mednet.ucla.edu

Phone: (310) 206-5900 Fax: (310) 2065901

\textbf{Objective:} Branch pulmonary artery stenosis is a persistent
problem following LeCompte maneuver of the pulmonary arteries (PAs) in
arterial switch operations as well as root translocation. Our technique
allows for elongation of the branch PAs as well as enlargement,
decreasing the narrowing that results from stretch.

\textbf{Case Video Summary:}

This video demonstrates the principle of spiral PA plasty whereby the
length of branch pulmonary arteries can be increased simultaneous to the
increase in diameter by using a patch that is anastomosed spirally
around the vessels.

In a porcine heart lung block, the ascending aorta is transected in
preparation for the ``Lecompte maneuver''.

The pulmonary arteries have been translocated anteriorly after extensive
mobilization up to the hilar branches.

The incision in the Pulmonary arteries is started posteriorly to
simulate the defects in the posterior sinuses left after coring out of
the buttons in an arterial switch procedure.

The spiral incision is taken cephalad and then brought anteroinferiorly
to the level of the hilum.

Now a PTFE patch is sutured to the left PA. The suturing is accomplished
from hilum to the central pulmonary bifurcation. This increases the
diameter of the LPA after patching.

A similar incision is made over the right pulmonary artery and a second
patch sutured in a spiral fashion. In clinical practice a patch made of
autologous pericardium or homograft is preferable to have tissue
handling similar to native pulmonary artery tissue.

You can observe that the width of the patch correlates to the increase
in the length of the pulmonary branches and that the length of the patch
corresponds to the increase in the diameter of the pulmonary arteries.

The final result of the patch plasty is demonstrated with greatly
enlarged diameter as well as length. The size of the patch can be
tailored to the needs of the patient.

Now the main pulmonary artery is anastomosed to the pulmonary artery
bifurcation in a manner similar to that done after arterial switch
taking care to maintain the increased dimensions after the branch PA
plasty.

The Right pulmonary artery shows the results of a more spiral incision
as compared to the left pulmonary artery which has a more traditional
incision.

\textbf{Conclusions:} This technique is important clinically for
surgical management of branch PA stenosis following LeCompte maneuver.
The elongation of the artery corresponds to the width of the patch and
the enlargement of the diameter corresponds to the length of the patch.

TABLE 1\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
ANIMAL & & PRE mm & POST mm\tabularnewline
\midrule
\endhead
PIG1 & LPA length & 14.7+12.0 & 34.9\tabularnewline
6116877 & LPA diameter & 8.46 & 17.7\tabularnewline
& RPA length & 13.29 & 34.4\tabularnewline
& RPA diameter & 8.66 & 14.1\tabularnewline
& MPA length & 28.8 & 34.3\tabularnewline
& MPA diameter & 13.8 & 12.5\tabularnewline
PIG 2 & LPA length & 12.01+14.76 & 15.71+12.24\tabularnewline
6174516 & LPA diameter & 8.46 & 15.71\tabularnewline
& RPA length & 13.29 & 16.4\tabularnewline
& RPA diameter & 8.66 & 20.18\tabularnewline
& MPA length & 14.1 & 24.0\tabularnewline
& MPA diameter & 14.9 & 18.0\tabularnewline
\bottomrule
\end{longtable}

FIGURE 1: Spiral pulmonary arterioplasty diagram\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

1: Posterior patch augmentation

2. Anterior patch continuation\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}

\textbf{Hosted file}

\verb`TABLE 1.docx`  available at \url{https://authorea.com/users/451742/articles/549932-recommendations-for-spiral-pulmonary-arterioplasty}

\selectlanguage{english}
\FloatBarrier
\end{document}

