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Anatomic correction of all the components of the syndrome of prolapsing right coronary cusp, dilatation of the sinus of Valsalva, and ventricular septal defect, can be achieved by a very simple technique. This technique can be applied in young children and prevents progression and secondary changes. Early correction in all patients with this syndrome is warranted.

Although the pulmonary autograft requires a significantly longer operating time, this does not seem to affect early and medium-term outcome when compared with results obtained with aortic homografts. Continued patient evaluation is warranted, particularly with regard to evidence of valve degeneration and right ventricular function and arrhythmias in the long term.

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The increasing numbers of long-term survivors following renal transplantation will complicate the surgical management of subsequent diseases. The donor renal artery may be anastomosed to the recipient iliac artery, and any interruption of proximal blood supply for reconstructive arterial surgery will compromise graft function. This case report describes the successful repair of an abdominal aortic aneurysm ( A A A ) in a renal transplant recipient with preservation of renal blood supply using a temporary heparin-bonded axillofemoral shunt * . Case reportA 56-year-old man presented with a I-h history of lower abdominal and back pain. Although having peripheral vasoconstriction he was haemodynamically stable with a blood pressure of 130,'90 mmHg. A pulsatile mass in the abdomen was confirmed by computed tomography to be a ruptured 7.5-cm infrarenal AAA.Some 24 years previously the patient had received a renal allograft, with vascular anastomoses to the right common iliac vessels (Figure 1 ), for the treatment of end-stage renal failure secondary to chronic glomerulonephritis. Long-term immunosuppression was maintained with prednisolone and azathioprine. The preoperative serum creatinine level was 137 pmol/l.To preserve transplant function during the period of aortic cross-clamping. a heparin-bonded temporary right axillofemoral shunt (Gott aneurysm shunt; Sherwood Medical, St Louis, Missouri, USA) was inserted before laparotomy. The procedure took 20 min and the infrarenal aorta was cross-clamped 30 min after the beginning of the operation. A straight aortic graft was inserted, and then a left aortofemoral graft was anastomosed side to side to the common femoral artery to bypass an iliac occlusion. The shunt was then removed with closure of the arteriotomies, without a patch.The patient's progress after operation was uneventful, although the serum creatinine level rose to 200 pumolll in the first week. This returned to preoperative levels within 2 weeks and renal function remains normal 18 months after operation. DiscussionThe extended indications for renal transplantation and increasing success of immunosuppression have resulted in a greater number of patients with functioning renal transplants. Despite successful transplantation, atherosclerotic vascular disease secondary to chronic renal failure and long-term haemodialysis may remain progressive in a population that is now living to an older age.Methods of preservation of graft function during the period of aortic cross-clamping for elective repair of AAAs include axillofemoral grafts or shunts, aortoiliac shunts', and femorofemoral bypass with a pump-oxygenator3. By contrast, there have been few reports of renal transplant recipients undergoing emergency surgery for ruptured aneurysms4.Lacombe uses no temporary vascularization of the transplanted kidney but transects the aorta between two clamps without opening the aneurysm sac'. The transplanted kidney is thus perfused at low pressure by retrograde flow from the inferior mesenteric, lumbar and iliac arteries w...