Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.

We describe rare cases of common arterial trunk (truncus arteriosus communis) with unbalanced atrioventricular septal defect, left ventricular hypoplasia, and restrictive ventricular septal defect. The embryology, hemodynamics, and the clinical implications of this complex combination are discussed.

A 7-year-old boy was diagnosed to have dilated cardiomyopathy with severe left ventricular (LV) dysfunction at 1 year of age. Although well compensated, his LV function remained impaired over the follow-up years. His electrocardiogram (ECG) was initially misinterpreted as left bundle branch block. However, on follow-up, it was recognized as a pre-excited ECG. The accessory pathway causing pre-excitation was implicated as the cause of LV dysfunction and dysynchrony as the mechanism. Radiofrequency ablation was done. His LV function and dimensions improved significantly over 6 months follow up.

A four-year-old girl presented with superior vena cava (SVC) type of sinus venosus defect, right upper pulmonary vein draining into right SVC-right atrium junction, left upper lobe pulmonary veins draining into the lower part of persistent left SVC (LSVC), and a patent ductus arteriosus. The anomalous pulmonary venous drainage to LSVC was overlooked in the preoperative evaluation and was found intraoperatively. Warden procedure was performed for right-sided veins. Lower LSVC draining the anomalous pulmonary veins was anastomosed to the left atrial appendage. The short stump of LSVC was diverted to left pulmonary artery. Anomalous pulmonary venous connections to LSVC are rare. Embryology of venous development is analyzed with respect to this rare anomaly, and options for surgical correction are discussed.

FIGURE 1. A and B, Kawashima completion by direct hemiazygos to left pulmonary artery connection and extracardiac hepatopulmonary connection to the right pulmonary artery completing total cavopulmonary connection. The pulmonary trunk was interrupted. IVC, Inferior vena cava; LSVC, left superior vena cava; RPA, right pulmonary artery; LPA, left pulmonary artery; HEP. VEIN, hepatic vein.