The bottom parts of the photographs indicate the direction of the patient’s head. (A) Stitches are placed for a single purse string suture in the ascending aorta. (B) A tourniquet to snare the cannula is applied. (C,D) For needle insertion, it is important to sense resistance twice. (C) First, at the outer wall of the false lumen. (D) Second, at the intimal flap.