We report our experience with a 3-5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 +/- 13.1 min, arrest time was 9.9 +/- 4.5 min, and crossclamp time was 20.7 +/- 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 +/- 9.2 min. The mean intensive care unit stay was 1.07 +/- 0.33 days, and hospital stay was 3.07 +/- 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.

Ascending aortic aneurysm is uncommon in the paediatric population, and because of the rarity the aetiology, natural progression, and prognosis of the disease remain unknown. A 7-year-old boy with ascending thoracic aortic aneurysm (60×67 mm) underwent graft anastomosis from the sinotubular junction to the undersurface of the arch. Analytical determinations including karyotyping and genetic mapping were all normal. To our knowledge, idiopathic aneurysm of the ascending aorta in children is very rare.

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A 15% of children with congenital heart disease also have an extracardiac abnormality. 1 Tetralogy of Fallot is occasionally associated with various well known extracardiac malformation. We report a rare extracardiac associatation of congenital bronchiectasis and Tetralogy of Fallot presented in late childhood with breathlessness on exertion and frequent respiratory infections. This late presentation was probably due to less destruction caused by oligemic lung of Tetralogy of Fallot. She was successfully managed by intracardiac repair and left upper lobectomy in a single setting. (Ind J Thorac Cardiovasc Surg 2010; 26: 34-37)

In present times, ventilation therapies such as intubation are more prominent, and difficulties have been reported during intubations [1-4]. Endotracheal intubations are critical in the resuscitation of the acutely ill and complications such as bradycardia and hypoxaemia have been reported [5-7]. Laryngoscopy is associated with a reflex sympathetic pressor response resulting in hypertension and arrhythmia [8-12]. During intubations, the haemodynamic responses are mostly short-lived and tolerated by healthy patients but can be detrimental in patients with cardiovascular diseases [13, 14]. Diverse views on the efficacy of intubating laryn