Persistence of the fifth aortic arch (PFAA) is a rare condition that results in the presence of an abnormal vessel originating from the distal ascending aorta proximal to the innominate artery. The distal connection and underlying cardiac or great vessel anomaly define the varied clinical presentations of this condition. CLINICAL SUMMARYA 1-year-old girl presented with cyanosis. On echocardiographic evaluation, she was given a diagnosis of tetralogy of Fallot with pulmonary atresia, patent ductus arteriosus, and collateral-dependent pulmonary blood flow. Angiocardiographic analysis showed a large vessel arising from the distal ascending aorta close to the innominate artery and joining the pulmonary artery (PA) confluence (Figure 1). Intraoperatively, she was found to have an abnormal artery (PFAA) arising from the posterior aspect of the ascending aorta close to the innominate artery and joining the PA confluence (Figure 2). She underwent total correction with closure of the ventricular septal defect, detachment of the PFAA from the ascending aorta, and pericardial patch plasty of the PA confluence. Right ventricle-PA continuity was established by using a valved porcine PA conduit. Her postoperative course was uneventful.
Late presentation of patients with large ventricular septal defect (VSD) and elevated pulmonary vascular resistance (PVR) is not uncommon in developing countries. Surgical VSD closure in these patients carries risks of persistent pulmonary hypertension, right ventricular failure, and mortality. Several techniques for creation of valved patches or fenestrated patches have been developed to address these issues. We have successfully used a simple and easily reproducible technique in which a cruciate fenestration is created in the patch used for VSD closure.
Objective: To compare left atrial (LA) versus Biatrial (BA) modified Maze using radiofrequency micro bipolar coagulation and cryoablation in patients with chronic AF and large LA(size>6cm).Methods: 47 patients of rheumatic mitral valve disease with atrial fibrillation (AF) and Left Atrial size>6cm underwent mitral valve surgery from March 2003 to June 2005. In addition to mitral valve surgery, they underwent either LA or BA modified maze procedure in two groups A and B consisting of 24 and 23 patients ( LA and BA Maze groups respectively).Both the groups were comparable in terms of age, gender and LA size. All patients who remained in AF following surgery underwent cardioversion on the 7th day.Amiodarone was given postoperatively for 3 months to all patients. All the patients were followed up after 3 months with electrocardiogram.Results: Mean age of patients were 35years, 23 were male(48.9%). Follow-up was done on 3rd month with ECG. Immediate postcardiopulmonary bypass, 12.5% of patients in group A and 26.1% of groupB had junctional rhythm, 29.2% of group A and 26.16% of group B converted to sinus rhythm and 58.3% of group A and 56.5% of group B remained in AF. 29.16% of patients in group A and 34.5% of group B converted to sinus rhythm at the end of 3months while 53.15% remained in AF.Conclusions: Both LA as well as BA modified maze procedure was effective in restoring sinus rhythm in only 29.16% and 34.5% of the study groups respectively. There was stastically no significant difference among the 2 groups studied in restoring patients to sinus rhythm at the end of 3 months.
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