Ecg of the month. Unusual electrocardiogram 42 years after operation for supravalvular aortic stenosis and 6 years after aortic valve replacement. Sinus rhythm with first degree atrioventricular block.

A 43-year-old man came to the hospital because of increasing dyspnea for two weeks. At age nine months the patient was evaluated for failure to thrive, and a diagnosis of valvular aortic stenosis was made. At operation the aortic stenosis was found to be supravalvular, and the ascending aorta was enlarged with a Teflon patch, the proximal end of which was placed in the noncoronary sinus of Valsalva.

Repair of large, iatrogenic, tracheo-esophageal fistulae.

Closure of large, iatrogenic, tracheo-esophageal fistulae present a formidable technical challenge. Our method of repair is presented, which describes the exposure and subsequent closure that relies on creating a new "membranous" trachea using remnant flaps of the esophageal wall of the fistula.