The Rastelli repair can be performed with low early mortality. However, substantial late morbidity and mortality are associated with conduit obstruction, left ventricular outflow tract obstruction, and arrhythmia.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Ecological Society of America is collaborating with JSTOR to digitize, preserve and extend access to Ecology.Abstract. The concept of the threshold food concentration that allows metabolic maintenance of an animal (CO) has been used as an analogy to Tilman's R* (equilibrium resource requirements) to explain competitive abilities of cladoceran species. Until now, however, theoretical analysis has been hampered because CO was measured in experiments where cladoceran growth was determined in response to fixed, low food concentrations, not as a result of the cladocerans' grazing activity. CO is an indirect estimate from nonequilibrium conditions. It still needs to be shown that growing Daphnia are efficient enough to suppress resource concentrations to levels equivalent to their CO. We designed flow-through experiments to establish equilibrium conditions between algal inflow and cladoceran population biomass with three differently sized Daphnia species. The equilibrium food concentration resulting from the daphniids' grazing activity was labeled C*, as it can be used to predict competitive abilities in analogy to Tilman's R*. Equilibrium was reached in each experiment. Daphnia grew to carrying capacity without fluctuations in numbers or biomass, and biomass remained constant after this level was reached. Mortality was compensated for by somatic growth or, in the case of the small species D. ambigua, by production of offspring. When the carrying capacity was reached, algal concentrations remained constant at C*. As predicted from previous growth experiments, larger species suppressed algal concentrations to lower levels, i.e., they were predicted to have higher competitive ability. This prediction was tested in a mixed-species experiment with D. pulicaria and the smaller D. galeata. That experiment clearly demonstrated the mechanism of exploitative competition. In the beginning, the smaller D. galeata performed better, but as soon as the food concentration fell below D. galeata's individually determined C*, the smaller species suffered mortality. At this point, D. pulicaria had not yet reached its C*. It continued to grow and replaced D. galeata. Numerical values of D. pulicaria's C* were slightly higher than the independently determined, corresponding CO values. This was to be expected as CO applies to zero mortality. However, the rank order among species was identical for both characteristics. We propose that both C* and CO have strong predictive power for mechanistic models of competitive interactions.

The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].

Results of operations for supravalvular aortic stenosis improved greatly after the introduction of more symmetric reconstructions of the aortic root. Multiple-sinus reconstructions (inverted bifurcated patch plasty and 3-sinus reconstruction) resulted in superior hemodynamics and were associated with reductions in both mortality rate and need for reoperation.