OBJECTIVES Different methods of aortic valve repair have been described in the literature for aortic regurgitation (AR) associated with doubly committed subarterial ventricular septal defects. Our goal was to present our experience with aortic valve reconstruction of a single leaflet using the aortic valve neocuspidization technique in this subset of patients. METHODS It is a retrospective review of 7 patients with doubly committed subarterial ventricular septal defects with significant (>moderate) AR who underwent the single-leaflet neocuspidization technique of aortic valve reconstruction from January 2016 to January 2019. Data were collected from medical records. All patients had thorough 2-dimensional echocardiographic assessment preoperatively and during the follow-up period. Primary end points were freedom from postoperative AR and freedom from reoperation and all-cause mortality within the follow-up period with secondary end points of freedom from thromboembolism and infective endocarditis. RESULTS Out of 7 patients, 6 were male and 1 was female. There were no perioperative deaths. The mean follow-up period was 2.6 ± 0.8 years. No deaths occurred during the follow-up period. At the latest follow-up examination, only 2 patients showed mild AR and were asymptomatic. There was no documented event of infective endocarditis or thromboembolism during the follow-up period. CONCLUSIONS The aortic leaflet neocuspidization procedure for the aortic valve is a relatively new concept. Availability of a template makes it an easily reproducible valve repair in paediatric patients with a single-leaflet abnormality. This technique preserves the remaining 2 normal leaflets, thus promoting the growth potential while maintaining near normal aortic root complex dynamics.

Nevertheless, congenital anomalies predominantly cardiac are still leading cause of under five-year-old mortality. There is significant global improvement has been observed in declining of under 5-year mortality from 93 deaths per 1,000 births in 1990 to 39 in 2017 (58%).Objective: The aim of this audit was to present our experiences of first hundred cases of congenital heart defects surgeries along with the challenges faced during the establishment of new pediatric cardiac surgery center in underprivileged area. Methods: This was an audit of the first 100 cardiac surgeries performed for congenital heart defects at Gambat Institute of Medical Science from 15- 3- 2021 to1-10-2022. During the period challenges other then related with surgical interventions; more than an investment of money but political, cultural, and social faced. Results: The mean age was 9+/-6.5 years, with female predominance of 57. Sever pulmonary hypertension was present in 6 patients.  The majority of our patients were from RACHS1 score category 1. Out of 100 patient open heart surgeries were 89(89%) and close heart were 11(11%). We have single mortality of patient underwent Tetralogy of Fallot correction developed massive stroke and expired at 5th postoperative day. Three patients were re explored for bleeding while one required emergency reopening in PICU for cardiac arrest. Post clamp removal arrhythmias were observed in 7(7%) patients. We received three patients in emergency from Pediatric cardiology post intervention including device embolization, device malposition and acute Mitral regurgitation post intervention. Conclusions: Providing Pediatric cardiac surgery services to the children of remote and socioeconomically deprived area is a greatly rewarding. It has many challenges other than providing direct patient care.

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Objectives: IABP is the most frequently used assist device in cardiac surgery. However, due to the poor socioeconomic status in our country, it is not always possible to use a brand new IABP when required. In these circumstances we use re-sterilized IABP catheters. Our aim was to compare the outcome of re-sterilized versus new IABP catheters in the set of patients who were provided surgery for IHD free of cost in a tertiary care hospital. Study Design: Retrospective study. Period: January 2007 to December 2013. Setting: National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Methods: 3560 CABG procedures were performed. Those patients who could not afford a new IABP catheter were provided with the resterilized balloon catheters, free of cost. Total IABP usage was 286(8%) patients, of which the new balloon catheter was used in 214patients [74.8% (groupI)]. Re-sterilized catheters were used in 72patients [25.2% (groupII)]. All patients were screened for HIV, Hepatitis- B and Hepatitis-C.12(16.6%) of the balloon catheters were resterilized more than once and 3(4.1%) of these on three occasions. Results: The mean age of the patients was 52.59±13.32 years. 69 (24.1%) of the patients were female. The mode of insertion (sheath less versus with sheath) was found tobe an independent risk factor for the development of complications. The overall incidence of complications (p=0.29) was 6.9%. The incidence of balloon catheter related complications was 1.75%. When the two groups were compared with regard to morbidity and mortality, the resultswere found to be statistically insignificant. Conclusion: Use of re-sterilized IABP catheters is safe. However, strict guidelines should be instituted and followed for this purpose.