IJTCVS, Jan–Mar, 2006

used. Continuous suture technique is relatively simple, easilyreproducible technique for VSD closure in pediatric patients and werecommend this technique for routine use.

Novel repair for obstructed total anomalouspulmonary venous connection to coronary sinusat the junction of coronary sinus to commonvenous chamberShivaprakash, Koshy S, Rao S, Prabhu AD, Kumar KAmrita Institute of Medical Sciences, Kochi

Purpose: To present a new technique to repair Cardiac type oftotal anomalous pulmonary venous connection (TAPVC) withobstruction at the junction of common venous chamber (CVC) andcoronary sinus (CS).

Methods: From January 2002 to December 2004 150 neonates andinfants underwent repair of TAPVC. Among them, 4 underwentsurgery for cardiac type that with obstruction at CVC and CS junction. Mean age and weight were 92 days (21-151 days) and 3.12 Kgs (2.1-4.3). A gradient > 5 mms across the junction was considered significantand were selected for new technique.

Technique: Under hypothermic bypass and cardioplegic arrest,CVC was dissected free from the heart. The junction of the CVC withthe CS was identified. Right atrium (RA) was opened transversely.CS was de-roofed up to its junction with CVC. Restrictive opening ofCVC was confirmed. Incision over RA was extended across ASD intothe posterior wall of LA. Working through the de-roofed CS, CS–CVCjunction was slit open into CVC. The incision was extended up toright pulmonary veins. A 2 cm incision in the CVC was sutured toposterior wall of the LA, thereby ensuring an unobstructed channelbetween two chambers.

Results: There was no mortality. Mean bypass and cross-clamptime were 83 mins (68- 101) and 45 mins (40- 49). Mean ventilation (53hours), ICU stay (74 hours), hospital stay (9 days) were unaltered.There was no gradient between CVC and LA. All 4 children are underfollow-up (6 months – 36 months). Echocardiography demonstratedunrestrictive opening in all children.

Conclusions: This technique is simple and easily reproducible. Itavoids suture lines in proximity of AV groove. It eliminates gradientacross junction of CVC and CS. Short term results have been gratifying.

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Improved outcome in TOF repair with modifiedpericardial monocusp valve augmentation inRVOTSwain S, Anil Kumar D, Reddy P, Nagarajan R, Agarwal R,Anil SR, Raghavan S, Murthy KSApollo Children’s Heart Hospital, Jubilee Hills, Hyderabad

Background: Patients with TOF with hypoplastic pulmonaryannulus require RVOT augmentation. Conventionally, pericardialpatch is used to enlarge RVOT and pulmonary regurgitation and rightventricular failure are a concern in this subset. To minimize thesecomplications, we use a modified monocusp pericardial valved patchfor RVOT reconstruction. We review our experience with this newtechnique.

Methods: Between March 2003 to October 2005, 203 patientsunderwent correction for TOF spectrum. Out of that, 102 patientsrequired RVOT augmentation. All of them underwent transannularpatch with monocusp valve. Monocusp pericardial valve wasprepared before CPB and the size of the patch was determined

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according to the pulmonary annulus and body weight. While suturingthe patch to the native pulmonary annulus, the free edge of the cutpulmonary valve was sutured to the pulmonary artery in such a wayto form a new cusp and became a competent valve in association withpericardial monocusp valve. The age range (6 months-18 years),weight range (4.5-47 Kgs). The spectrum included, TOF ( 67), DORV(22), absent pulmonary valve ( 11) and annular PS in 2. In 62pulmonary valve was tricuspid, 29 bicuspid and 11 had rudimentaryvalves.

Results: The mean duration of ventilation was 28.4 hrs (12 hoursto 5 days) and mean ICU stay was 2.6 days (2 to 8 days). Post operativeechocardiography showed mild PR in 90 patients, moderate in 12patients and no RVOT obstruction. There were 3 post operativemortality

Conclusions: RVOT reconstruction with transannular pericardialpatch with monocusp valve reduces the incidence of free PR inimmediate post operative period, provides better post operativehaemodynamics and reduces post operative morbidity.

Cantrell’s syndrome: A report of two casesIyer A, Nagi GS, Krishna Manohar SR, Jayakumar KSree Chitra Tirunal Institute for Medical Sciences andTechnology, Trivandrum

Introduction: Cantrell’s syndrome is a challenge to any surgeondespite modern surgical standards. Cantrell’s syndrome ischaracterized by defects of the lower sternum, anterior diaphragmand parietal pericardium, an omphalocoele, partial herniation of theheart through the diaphragmatic defect and congenital heart disease.We report to be surgical management of two such Cases.

Methods: Two patients with a pre-operative diagnosis of Cantrell’ssyndrome were operated at our institute between Jan 1996 & July2005. The first case was a three-year-old girl with ventricular septaldefect while the second was a four year old with pulmonary atresia,double outlet right ventricle with and left pulmonary artery stenosisin the second case. Both these patients underwent surgical correctionfor their defects. The first case underwent surgical repair of theumbilical hernia three months later.

Results: Both patients were operated successfully. They had nocomplications post-operatively and are alive and well at follow up.

Conclusions: Cantrell’s syndrome is a rare congenital anomaly,which is surgically correctable in majority of the patients. There is aneed for a multi-disciplinary approach to ensure full correction of alltheir anomalies.

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Technique of bi-directional cavopulmonaryshunt when there is partial anomalouspulmonary venous connection to superiorvenacava: A Case reportBansal N, Iyer AP, Krishna Manohar SR, Jayakumar KSree Chitra Tirunal Institute for Medical Sciences and Technology,Trivandrum

Introduction: Bi-directional cavopulmonary shunt (BCPS) is acommon procedure in a patient with functional single ventricle onthe way to Fontan completion. The procedure becomes challengingwhen there is an associated anomalous pulmonary venous connectionto the SVC. We describe the surgical process in one such case, whichwas managed by performing an anastomosis between the SVC andthe branch pulmonary artery by transecting the MPA and mobilizingthe branch PA’S and the SVC.

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Congenital 2006; 22: 40