with re-attachment to a single patch was widely employed in the earlier days 2 . Trusler introduced the two patch technique 3 and many subsequent investigators believed that this preserved atrioventricular valve (AV Valve) function better 4,5 . However, a careful review of different published series of repairs using one or two patch technique failed to document that one technique was superior to the other 6 . Wilcox and associates employed the technique of suturing the common atrioventricular valve to the ventricular septum to close the VSD and a patch to close the ASD. They excluded patients with a large ventricular component 7 . Nicholson and Nunn extended this simplified single patch technique to all sizes of the VSD 8 . They added a form of anterior "annuloplasty" during partitioning of the common AV valve. We are presenting our experience with this technique in fifteen consecutive infants. All sizes of VSD were included but annuloplasty was not performed. We found that this technique greatly simplified the repair of complete AVSD and was easily AbstractBackground: There has been a rekindling of interest in alternatives to conventional two patch technique for the repair of complete atrioventricular septal defect in infancy in the recent past. We applied the simplified single patch technique to 15 consecutive infants and herein report our intermediate term results. Methods: Between March 1998 and September 2001, fifteen patients underwent repair of complete atrioventricular septal defect with this technique (mean age 6 months, mean weight 5.4 kg). Downs syndrome was present in 11 patients. Repair was done in all patients by direct suturing of the common atrioventricular valve leaflets to the crest of the ventricular septum irrespective of the size of the ventricular septal component. The cleft in the anterior mitral leaflet was closed in all patients. The atrial septal component was closed by a pericardial patch.Results: There was no mortality. There were no pulmonary arterial hypertensive crises or heart block. The mean follow up was 13.2 months. One patient underwent mitral valve replacement after one year due to severe mitral regurgitation. The remaining fourteen patients had no significant mitral regurgitation, residual ventricular septal defect or left ventricular outflow tract obstruction on echocardiography.Conclusion: Simplified single patch technique is an easily reproducible method for surgical repair of complete atrioventricular septal defect. It is less time consuming and minimises ischaemic time. Atrioventricular valve function is preserved and there is no incidence of obstruction to left ventricular outflow tract. The intermediate term results are encouraging. (Ind J Thorac Cardiovasc Surg, 2003; 19: 102-107)

Background: The major strategy for palliation of cyanotic lesions in neonates is the systemic to pulmonary arterial shunt.Methods: Between May 1995, and December 2002, 48 consecutive neonates underwent systemic to pulmonary arterial shunts for cyanosis with reduced pulmonary blood flow. The mean age was 11.6 days (_+SD 7.38) and the mean weight, 3.2kg (+SD 0.52). The babies were classified into three groups: Group I -Tetralogy -pulmonary Atresia (n=18), Group II -Single Ventricle -Pulmonary atresia without (n=19) and with (n=5) isomerism, Group III-Pulmonary Atresia with Intact ventricular septum (n=6). Diagnosis was made by 2D echocardiography. Indication for cardiac catheterization was delineation of pulmonary anatomy / ductus laterality (n=4) or balloon atrial septostomy (n=4). The surgical procedure was a modified Blalock-Taussig shunt on the side of the situs. Post-operatively, no anti-coagulation or anti-platelet medication was employed.Results: There was no mortality. Four cases required revision of the shunt in the immediate post-operative period for shunt thrombosis. The mean follow up was 17.54 months (_+SD 8.36). In Group I, nine patients have undergone total correction with or without a conduit, while three required new arterial shunts for shunt/pulmonary artery stenosis. In Group II, nine patients have undergone bi-directional Glenn with atrial septectomy (n=2) and pulmonary artery plasty (n=4) and one patient underwent Fontan completion. In Group III, two patients underwent bi-directional Glenn and two had pulmonary valvotomy with/without right ventricular outflow tract widening. All the remaining babies are waiting for the second/final stage palliation or total correction.Conclusion: Systemic to pulmonary arterial shunts in neonates is a gratifying and reasonably safe surgical procedure. Most babies become candidates for eventual univentricular / bi-ventricular repair. (Ind J Thorac Cardiovasc Surg, 2003; 19: 159-162)

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