Aortic arch repair following the Norwood operation remains challenging because of dense adhesions and the risk of phrenic or recurrent nerve injury. We present a novel approach employing descending aortic antegrade perfusion using a balloon catheter to minimize the extent of dissection.

A 2-year-old male with hypoplastic left heart syndrome and post-Norwood operation underwent aortic arch repair. A balloon catheter was inserted through the aortic arch for simultaneous descending aortic occlusion and distal antegrade perfusion. This eliminated the need for external clamping. The procedure was successful with no nerve paralysis.

This technique reduces the dissection area, mitigating nerve injury risks. Furthermore, it ensures continuous lower body antegrade perfusion, protecting visceral organs independent of deep hypothermia.

Simultaneous descending aortic occlusion and antegrade perfusion using a balloon catheter represents a safe, feasible strategy for complex arch repair, potentially reducing morbidity in high-risk single-ventricle patients.