Early experience with surgical strategies aimed at preserving the pulmonary valve and annulus during repair of tetralogy of Fallot.

Background: During repair of tetralogy of fallot (TOF) we modified surgical strategies to preserve the valve and annulus if the pulmonary valve leaflets are pliable and not significantly dysplastic.

Methods: Initially, the repair was done from the main pulmonary artery (Group-1, 215 patients) and later through an additional incision in the infundibulum of the right ventricle (Group-2, 73 patients). Recently, we changed the approach to commissurotomy of the fused leaflets by releasing the supra valvar tethering and delamination of the cuspal apparatus till the base to improve the mobility of the cusps and do a controlled commissurotomy (Group-3, 14 patients).

Early Experience With Pulmonary Root Translocation in Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction.

Background: The optimal surgical management of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO) is debatable. This is our initial experience with pulmonary root translocation (PRT), a technique that aims to preserve the pulmonary valve function.

Methods: From July 2012 to October 2019, 16 patients underwent anatomical repair for TGA, VSD, and LVOTO.

Avoiding use of total circulatory arrest in the practice of congenital heart surgery.

Deep hypothermic circulatory arrest (DHCA) technique has been an important armamentarium in the correction of congenital heart diseases. There have been many controversies and concerns associated with DHCA, particularly neurological damage. Selective ante grade cerebral perfusion (SACP) was introduced as an adjunct to DHCA with the objective of limiting the neurologic injury during aortic arch repairs.

Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants.

Background: In coarctation of aorta associated with proximal arch hypoplasia, extended end-to-end anastomosis through a thoracotomy would result in a residual gradient between the origins of the innominate and the left common carotid arteries. To eliminate this, we modified the surgical technique.

Patients And Methods: Between March 2012 and May 2017, 50 patients (14 neonates) underwent repair of coarctation of aorta through a thoracotomy.

Preliminary Experience With the Use of an Extracellular Matrix to Augment the Native Pulmonary Valve During Repair of Tetralogy of Fallot.

Background: During repair of tetralogy of Fallot (TOF), when a transannular patch is needed in case of a small annulus and dysplastic pulmonary valve, we chose to reconstruct the right ventricular outflow tract by augmenting the divided anterior leaflet with an extracellular matrix (ECM) patch to produce a competent valve. In this study, we present our preliminary experience and early outcomes.

Methods: From March 2013 to December 2015, of the 206 patients who underwent primary repair of TOF, 52 required a transannular incision.

Venoatrial shunt-assisted cavopulmonary anastomosis.

The bidirectional Glenn shunt operation is conventionally performed under cardiopulmonary bypass. Between June 2007 and September 2009, 218 consecutive patients underwent off-pump bidirectional Glenn shunt institution for single ventricle with pulmonary stenosis complex. Their mean age was 4.

Off-pump Kawashima operation.

We describe the technique of Kawashima repair without using cardiopulmonary bypass in 6 consecutive patients of single ventricle morphology with interrupted inferior vena cava and pulmonary stenosis. No patient had central nervous system disorder or chylothorax. The off-pump technique is feasible in Kawashima repair.

Veno-venous shunt-assisted cavopulmonary anastomosis.

Objective: The bidirectional Glenn shunt is commonly performed under cardiopulmonary bypass for conditions that lead to a single ventricle repair. We report our experience of bidirectional Glenn shunt done without cardiopulmonary bypass.

Methods: Between June 2007 and May 2009, 186 consecutive patients underwent off-pump bidirectional Glenn shunt for a variety of complex cyanotic congenital heart defects.

Sternotomy approach for modified Blalock-Taussig shunt: is it a safe option?

Central aorta-pulmonary artery shunts have fallen into disfavor because of shunt thrombosis and congestive heart failure, and a modified Blalock-Taussig shunt via thoracotomy can lead to pulmonary artery hypoplasia and distortion. We reviewed the outcomes of a modified Blalock-Taussig shunt by a sternotomy approach in 20 infants from July 2007 to October 2009. Their mean age was 5.

Valve repair in rheumatic heart disease in pediatric age group.

Valve repair in children is technically demanding but more desirable than valve replacement. From April 2004 to September 2005, 1 boy and 8 girls with rheumatic heart disease, aged 2-13 years (median, 9 years), underwent valve repair for isolated mitral regurgitation in 5, combined mitral and aortic regurgitation in 2, mitral stenosis in 1, and mitral regurgitation associated with atrial septal defect in 1. Chordal shortening in 7, annular plication in 6, commissurotomy in 1, reconstruction of commissural leaflets in 7 were performed for mitral valve disease.

Neonatal Blalock-Taussig shunt: technical aspects and postoperative management.

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively.

Morphosurgical correlation of outcomes in complete double outlet right ventricle.

Even though surgical experience with wide spectrum of double outlet right ventricle (DORV) is available, the experience with extreme form of complete DORV where both great arteries completely arise from the right ventricle is limited. We present our experience with this unique subset where the systemic outflow is far removed from the interventricular foramen and hence, the systemic ventricle. In this situation, biventricular repair can be technically demanding and challenging.

Right ventricle to pulmonary artery connections.

From March 1988 through June 1995, 80 patients underwent repair for right ventricle (RV) to pulmonary artery (PA) discontinuity. Of these, 30 patients received homograft conduits, while the remaining 50 underwent repair without the use of a homograft. Handmade pericardial valved vascutek conduits (n = 18), non-valved vascutek tubes (n = 13) and non-conduit procedures like the rev operation (n = 12) and extended pericardial gusset (n = 5) were mainly used.

Pulmonary autograft aortic valve replacement. Early experience with the Ross procedure.

Aortic valve replacement with a pulmonary autograft was performed in 24 patients between October 1993 and October 1994, at the All India Institute of Medical Sciences, New Delhi. There were 20 (83.3%) males and 4 (16.