The heart is accessed via median sternotomy, and the patient is given heparin to prevent the blood from clotting. A generous section of pericardium is harvested, then disinfected and sterilized with a weak solution of glutaraldehyde; and the coronary and great artery anatomy are examined. The ductus arteriosus and right pulmonary branch, up to and including the first branches in the hilum of the right lung, are separated from the surrounding supportive tissue to allow mobility of the vessels. Silk marking sutures may be placed in the pulmonary trunk at this time, to indicate the of the aorta to the neo-aorta; alternatively, this may be done later in the procedure.