From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninety percent were in the 20- to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.

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From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 +/- 1.2 hours, aortic crossclamp time was 58 +/- 16 minutes, intensive care unit stay was 22 +/- 7 hours, and hospital stay was 6.4 +/- 1.2 days. Median postoperative blood loss was 332 +/- 104 mL. There was 1 hospital death. On follow-up at 16.4 +/- 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 +/- 0.5 to 1.4 +/- 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.

Introduction: Tetralogy of Fallot in adults is a surgical challenge owing to the long-standing hypoxic myocardium. Trans-annular patching (TAP) in comparison to an outflow-tract patch (OP) is speculated to cause progressive right ventricular dysfunction due to free pulmonary regurgitation. We present the results of objective assessment of surgical correction in an adult population at mid-tenn follow up.Methods: Ninety patients over the age of twelve years with a Tetralogy of Fallot operated between Jan 1995 and June 2004 at our institution, of which thirty-two patients underwent objective assessment of ventricular function by Tread Mill Testing (TMT) alongwith echocardiography at mid-term follow up, are included in this series. Mean age at surgery was 19.5±6.3 years. The male-to-female ratio was 2.2:1. Twenty-five patients I had undergone an intra-cardiac repair with TAP while seven had the repair with right ventricular OP.Results: Follow up ranged from 6 months to 9 years with a mean of 6.02 years. TMT showed good ventricular function in 31/32 (96.8%) patients with an average of 1 0.3 METS attained along with moderate pulmonary regurgitation on echocardiography. One patient (3.2%) with TAP had poor exercise tolerance with 5 METS achieved on TMT along with severe pulmonary regurgitation on echocardiography. Twenty-six patients were in NYHA class I, six in class II and only one in class III.Conclusions: Complete lntracardiac repair of Tetralogy of Fallot with TAP can be done with acceptable I morbidity. TAP does not appear to be significant risk factor for right ventricular failure at midterm follow up.

Background: Lower hemisternotomy is a popular minimally invasive approach to correct cardiac lesions. Since June 2000, we started the programme of minimally invasive approach for a variety of cardiac lesions. For the same we have indigenously designed a set of instruments.Methods: Total of 86 patients were operated through this approach. The cardiac lesions corrected include atrial septal defect (ASD) in 60 patients (70%), ventricular septal defect (VSD) in 12 (14%) and mitral valve replacement (MVR) in 14 (16%). The results of ASD closure in 40 patients done through this approach were compared with the control group of patients who underwent ASD closure through full-length sternotomy.Results: In patients in whom ASD closure was done, the mean CPB and aortic cross clamp time in lower hemisternotomy group were significantly longer, 35±14.2 min and 23.3±10.8 min respectively compared to 23±3.9 min and 14±3.5 min in full sternotomy group (p<0.001). Mean ventilation time, blood loss, ICU and hospital stay were significantly low (p<0.001) In patients who were operated through this approach compared with those who were operated through full-length sternotomy.Conslusion: Lower Hemisternotomy is a safe approach in both the pediatric and adult patients and the indigenously designed instrumentation is simple and reusable which helps in improving the operative exposure and ease of surgery.