When the patient is fully cooled, the ascending aorta is clamped as close as possible below the HLM cannula, and cardioplegia is achieved by delivering cold blood to the heart via the ascending aorta (below the cross clamp). The aorta is then transected at the marked spot, and the pulmonary artery is transected a few millimetres below the bifurcation. The vessels are again examined, and the pulmonary root is inspected for left ventricular outflow tract obstruction (LVOTO). If a ventricular septal defect (VSD) is present, it may be repaired, at this point via either the aortic or pulmonary valve; it may alternatively be repaired later in the procedure.