had required pulmonary artery banding and 22 patients had systemic to pulmonary artery shunts. The median duration of stay in the intensive care unit was 3.5 days (range 2 60 days) and the median duration of total hospital stay was 8 days (range 5 60). There were no hospital deaths; one patient died 5 months after discharge due to an arrhythmogenic cardiac arrest during a median follow up of 30 months [long term survival 98% (95% CI 89 100%)].Conclusions: The double switch operation may be performed with excellent hospital and long term survival. The theoretical advantages of this procedure which enables the morphologic left ventricle and mitral valve to support a systemic pressure load must be established by careful follow up of these patients.

had required pulmonary artery banding and 22 patients had systemic to pulmonary artery shunts. The median duration of stay in the intensive care unit was 3.5 days (range 2 60 days) and the median duration of total hospital stay was 8 days (range 5 60). There were no hospital deaths; one patient died 5 months after discharge due to an arrhythmogenic cardiac arrest during a median follow up of 30 months [long term survival 98% (95% CI 89 100%)].Conclusions: The double switch operation may be performed with excellent hospital and long term survival. The theoretical advantages of this procedure which enables the morphologic left ventricle and mitral valve to support a systemic pressure load must be established by careful follow up of these patients.

Background. Ebstein's anomaly of the tricuspid valve is a complex malformation. Historically, because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties with or without associated procedures.An individualised combination of surgical procedures was practised over three years and forms the subject of this presentation.Method. Between November 1995 and September 1999, 7 patients with Ebstein's anomaly underwent surgical repair (age 3.5 to 40 years). Cyanosis with severe tricuspid regurgitation was present in all. Surgical repair, individualised according to the morphology of the tricuspid valve and right ventricle to provide maximum possible symptom free survival, included, (1) Tricuspid valve: Replacement (n = 1); Repair (Carpentier type n = 1, Unicuspid repair n=5), (2) Atrial septal defect: left open (n = 1), closed partially (n = 1), closed compeletely (n = 5), a n d (3) Bidirectional Cavopulmonary S h u n t (BCPS) -4Results. There was no hospital death. Intraoperative transoesophageal echocardiography showed only mild tricuspid regurgitation in all, following repair. There were no late deaths at a mean follow up of 29 months. All but one patient were in functional Class 1 New York Heart Association(NYHA). Complications included a thrombus in the right ventricular cavity six months postoperatively in one patient.Conclusion. Individualisation of surgical management in Ebstein's anomaly provides optimal results. (Ind J

Introduction: Approach to repair of Ostium Secundum atrial defect has undergone modifications in the last decade, with right thoracotomy, being one common approach pursued by.Methods: Right Posterolateral thoracotomy (RPLT) was offered for ASD closure for children, young females below 30 and selected adult male patients with lean body built. Retrospective analysis of these patients with conventional median sternotomy approach over a period of 3 years in this center was included, excluding patients with ostium primum. ASD and associated conditions like PDA, VSD, Mitral valve prolapse, coronary artery disease etc. Common variables including pump time aortic cross clamp time, postoperative ventilation, ICU stay, morbidity were considered for analysis. There were 225 (130 male and 95 females) patients in sternotomy group vs 96 (65 males and 30 females) in RPLT group. The average age in sternotomy group was 36 years (range 2 to 46 years) as compared to 13 years (range 3 to 27 years). Direct closure of ASD was done in 71 patients and pericardial patch closure for 154 patients in sternotomy group, compared with 66 and 20 in the RPLT group.Results: Extra corporeal circulation time was 46 minutes (37 to 90) in sternotomy group, Aortic cross clamp time 22 minutes (18 to 38) in former as compared to 32 minutes (28 to 45) 14 (8 to 36) in the latter. Blood loss in postoperative period was 210 ml (range 40 600 ml in sternotomy group while it was 160 ml range 20 400 ml) in thoracotomy group. Selective ventilation was provided in all patients. Postoperative complications included ( 3 vs. 1). The opening sternal rewiring (31 pain and shoulder movement restriction (12), and secondary suturing (5 patients in RPLT group). The cosmetic appeal of the incision was acceptable for most of the parents of female patients in thoractomy group.Conclusions: Right posteroilateral thoracotomy for ostium scundum ASD closure in a suitable approach as it gives equally good results as median Sternotomy. Patient selection is an important factor.Background: Successful neonatal repair of infradiaphragmatic total anomalous pulmonar T drainage (TAPVD) depends largely on early intervention which in tmn is dependent on early diagnosis, referral and transportation.Methods: Five neonates underwent complete repair of isolated infradiaphragmatic (Obstructed) TAPVD from January 1995 to November 2003. All patients were referred from distant places. Two were males, ages ranged from 6 days to 35 days. Emergency operative correction was performed after instituting resuscitative measmes. The common confluence to LA anastomosis was done, vertical vein ligated and ASD closed in all cases. The mean CPB time was 80 min.

Background: Thoracic aortic coarctation and associated intracradiac pathology including a concomitant