An Unusual Presentation of Double-Outlet Right Atrium.

We describe an unusual example of double-outlet right atrium with separate atrioventricular junctions. The straddling and overriding tricuspid valve had two orifices, and the mitral valve was morphologically normal. An appropriate understanding of the morphology of the atrioventricular junctions, the valves, and the subvalvar apparatus, along with the location of the atrioventricular conduction axis, allowed for successful biventricular repair.

Bronchial decompression following repair of absent pulmonary valve: Fine-tuning by procedural fiberoptic bronchoscopy.

Marked aneurysmal dilation of the central and branch pulmonary arteries in utero in patients with tetralogy of Fallot with absent pulmonary valve can often exhibit extrinsic compression of the trachea and bronchi. The major morbidity in these patients remains postoperative ventilation issues. This case report highlights the role of intraoperative bronchoscopy in providing guidance for obtaining optimal bronchial decompression that was achieved by an initial pulmonary arteriopexy followed by an aortopexy.

On-Table Verification of Aortopulmonary Shunt Patency Through Ipsilateral Pulmonary Venous Blood Flow Assessment by Transesophageal Echocardiography.

Intraoperative transesophageal echocardiography is a well-established modality for the evaluation of the adequacy of the surgical repair of complex congenital heart lesions. This case report highlights the important role played by real-time transesophageal echocardiography during the evaluation of the patency of a left modified Blalock-Taussig shunt in a child with pulmonary atresia, nonconfluent pulmonary arteries, and borderline hemodynamic/ventilator parameters. Changes observed in the pulmonary venous blood flow pattern provided reassurance to the surgical team about the patency of the shunt and thereby avoided its reconstruction.