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Strict selection criteria governing an 'adequate' aortic rim, the size of the device, and the choice of the device may help reduce the incidence of complications like the rare, but potentially fatal embolization of the device into the pulmonary artery following percutaneous device closure of an ASD.

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Scimitar syndrome is a rare variant of partial anomalous pulmonary venous connection. The combination of scimitar syndrome with anomalous connection of the left superior pulmonary vein to the left innominate vein is extremely rare, and is yet to be documented in literature. We report the successful single-stage correction of such a rare type of anomalous pulmonary venous connection.

Esophageal carcinoma has, over the past decade, undergone a sea of change, not only in its pathological distribution, but also in the diagnosis, staging and subsequent management. Although the advent of better imaging techniques has helped in diagnosing patients at an earlier period, the majority of them have unresectable disease at the time of presentation. Despite aggressive treatment protocols involving either one or a combination of the options of surgery, radiation, and chemotherapy, the fiveyear survival remains dismal in the order of 10 to 15%. The two most commonly used surgical techniques for resecting the esophagus, the Ivor Lewis and the transhiatal esophagectomy, have similar results in terms of morbidity, mortality and, more importantly, five-year survival following resection. There has been an increasing interest in the surgical treatment of carcinoma esophagus by a minimally invasive approach, as meta-analysis of clinical series have shown that a faster recovery time without any statistically significant difference in the in-hospital mortality or morbidity when compared to conventional surgery. Nonrandomized studies suggest that patients receiving neoadjuvant chemo-radiation have a five year survival advantage compared with those treated with surgery alone, especially if they had a complete histological response to the preoperative regimen. Lastly, palliative procedures, form the mainstay of management of patients with non-resectable disease.

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Background: Fontan procedure and its modifications are established procedures for the treatment of anatomical defects with a single ventricle physiology.Methods: Thirty-two patients underwent extra-cardiac Fontan procedure between Feb 2004 and Oct 2005. Pre-operative cardiac catheterization was done in all patients. All cases were operated on cardiopulmonary bypass with beating heart. ePTFE conduit (Gore-Tex) was used to create an extra cardiac connection between inferior vena cava and the pulmonary artery. A fenestration was created between the conduit and right atrium in twenty-seven patients (91%) Results: The average age was 8.7 years (range 3-21yrs). Ten females underwent the operation. The pre-operative diagnosis was tricuspid atresia (n=15), DORV (n=8), DILV (n=3) and others (n=6). Three patients had PA banding and eight had a BT shunt prior to the bidirectional Glenn. The average pre-procedure pulmonary artery pressure was 11.9 mm Hg (range 7-16) and LVEDP was 10.6 mm Hg (range 7-18). The average branch PA size was 12.6 mm/m 2 (range 8.9-15). 20mm (n=10) or 22 mm (n=12) PTFE conduits were used. Twenty-nine patients (91%) survived the procedure. Postoperative complications were pleural effusion (n=9), renal failure (n=3) and bleeding (n=1). Technical problems during re-sternotomy (aortic injury in one and coronary artery injury in another) and poor PA anatomy were the causes for mortality. Arterial oxygen saturation increased from an average of 76.33% (pre-operative) to 94.5% (postoperative).Conclusions: Extra cardiac Fontan is a technically simple procedure that avoids an atrial suture line resulting in a theoretical reduction in the risk of atrial arrhythmias. However, careful selection of cases is mandatory to avoid early mortality.

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