A significant proportion of patients with isomerism still die before reaching adulthood. Only a fraction of those with obstructed pulmonary veins survive. Having biventricular repair does not confer a survival advantage to those born with right atrial isomerism.

Traumatic aortic injuries are associated with high morbidity and mortality, and the ideal operative approach for surgical management is unclear. We analyzed our results with the open clamp-and-sew technique over a 20-year period. Twenty patients with transected aorta were given interposition grafts; 19 of them had multisystem injuries. Mean aortic crossclamp time was 21.7 min (range, 12-30 min). Postoperative complications included pneumonia in 4 patients, acute renal failure in 1, recurrent laryngeal nerve injury in 2, chylothorax in 1, and sepsis of unknown etiology in one. There was no incidence of operation-related paraplegia. Although there was no 30-day mortality, one patient died after 90 days from diffuse axonal injuries to the brain. In experienced hands, the clamp-and-sew technique is effective and safe for the management of traumatic aortic transection.

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IntroductionOver the past few years, there has been an increasing stress on eliminating or at least minimizing the morbidity associated with cardiopulmonary bypass. The advent of mechanical stabilizers and intracoronary shunts has greatly contributed and facilitated the trend towards beating heart coronary revascularization. Consequently, off pump coronary artery bypass grafting technique is being increasingly used as an alternative to conventional on pump coronary artery bypass in many centers worldwide. Off pump coronary revascularization via left thoracotomy though AbstractBackground: There are very few studies in literature, which have reported primary revascularization of the coronaries via a thoracotomy incision. We hereby present our initial experiences using this approach to off pump coronary revascularization.Patients and Methods: 27 patients with coronary artery disease were selected for surgical revascularization via the thoracotomy approach. The left chest is entered through the 5 th intercostal space, and the left internal mammary artery (LIMA) pedicle is harvested under direct vision. The radial artery or saphenous vein is harvested simultaneously depending on the availability and suitability of the conduits. Using standard off pump techniques, the LIMA is anastomosed to the Left Anterior Descending Artery (LAD) followed by other distal anastomoses.Results: Complete revascularization was achieved in all patients. The average number of grafts were 2.40. The mean blood loss during the first 6 hours was 380 ± 169 ml. None of the patients needed emergency conversion to cardiopulmonary bypass / sternotomy. Post operatively 4 patients had on table extubation. 1 patient was re-explored due to bleeding from the thoracotomy. There was no peri-operative Myocardial infarction and the mortality was nil. The average hospital stay was 6.4 ±1 days.Conclusion: Based on our initial experience, this approach appears to be safe and practical in selected cases. It is well tolerated hemodynamically, with minimal postoperative morbidity. (Ind J Thorac Cardiovasc Surg 2007; 23: 236-239)

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