There was no correlation between duration of ventilation with age, weight, and right ventricle/left ventricle ratio. Early extubation in patients after intracardiac repair in tetralogy of Fallot is safe and effective.

We report our experience with a 3-5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 +/- 13.1 min, arrest time was 9.9 +/- 4.5 min, and crossclamp time was 20.7 +/- 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 +/- 9.2 min. The mean intensive care unit stay was 1.07 +/- 0.33 days, and hospital stay was 3.07 +/- 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.

A 15% of children with congenital heart disease also have an extracardiac abnormality. 1 Tetralogy of Fallot is occasionally associated with various well known extracardiac malformation. We report a rare extracardiac associatation of congenital bronchiectasis and Tetralogy of Fallot presented in late childhood with breathlessness on exertion and frequent respiratory infections. This late presentation was probably due to less destruction caused by oligemic lung of Tetralogy of Fallot. She was successfully managed by intracardiac repair and left upper lobectomy in a single setting. (Ind J Thorac Cardiovasc Surg 2010; 26: 34-37)

Pseudoaneurysm of the ascending aorta is rare in infants, with few cases reported in the literature. These aneurysms are usually mycotic, occurring after cardiac surgery, or caused by mediastinitis. They have high risk of spontaneous rupture. Surgery is usually complex because of the need for peripheral cannulation in small infants. We report an ascending aortic pseudoaneurysm in a less than 3-month-old infant that occurred within a month after repair of type 2 truncus arteriosus and was managed successfully with a modified cardiopulmonary bypass strategy.

Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1–2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful.

There are several potential issues that affect the treatment and diagnostic pattern of anomalous left coronary artery arising from the pulmonary artery. We report three cases of infants who presented with anomalous left coronary artery arising from the pulmonary artery with severe left ventricular dysfunction and severe mitral regurgitation along with associated anomalies. One patient had congenital lobar emphysema of the right midde lobe. Another patient had left main stem bronchus compression, collapse of basal segments of left lower lobe and panlobular emphysema in medial basal segment of right lower lobe. The third patient had cleft lip and palate. All patients underwent successful repair. The hemodynamic stability was compromised when the infant with congenital lobar emphysema had spontaneous pneumothorax after extubation and she needed an intercostal drainage. The infant with lung collapse had to be reintubated on the second day since she became hypoxic due to recollapse of the lung once the airway positive pressure was removed. She needed chest physiotherapy, vigorous endotracheal suctioning and inhaled bronchodilator therapy. The patient who had cleft palate succumbed to aspiration pneumonitis in the postoperative period. Follow-up of other two patients after three months showed very good improvement in left ventricular systolic function.

No abstract

No abstract