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Tracheal reconstruction with a new type of prosthesis made of heavy Marlex mesh and pericardium is described in 13 patients suffering from malignancy. Two patients had circumferential excision of the trachea, and the remaining 11 had partial circumferential excision and a patch graft. In 10 of them, tracheal excision was a part of block pulmonary resection. The early results are good enough to allow us to continue using the prosthesis in suitable cases.

Surgical correction was carried out successfully in a severely cyanotic 3-year-old Japanese girl who had a very rare type of double-outlet right ventricle. The malformation was associated with bilateral conus, 1-transposition of the great arteries, and subpulmonary ventricular septal defect without significant pulmonary stenosis in situs solitus. A large amount of subaortic conal musculature which separated the aortic valve from the subpulmonary ventricular septal defect was removed, as was the anterior rim of the ventricular septal defect. A tunnel, constructed with a woven Teflon prosthesis, was inserted in such a manner as to direct blood from the left ventricle through the defect and out to the aorta. The pulmonary outflow tract was reconstructed with a Teflon patch lined with pericardium. The patient's postoperative recovery was uneventful, and she was doing well 3 months postoperatively. To our knowledge, no identical case with a similar type of surgical correction has previously been reported.

This report outlines orthoterminal correction in an 8-year-old boy with coexisting d-transposition of the great arteries (d-TGA), subpulmonary stenosis, and a complete form of atrioventricular canal (CAVC). The repair consisted of covering the tricuspid valve and atrial part of the atrioventricular canal with a Dacron patch and inserting a valve-containing conduit between the then isolated right atrium and the pulmonary artery to create a venous outlet. The patient's exercise tolerance has improved remarkably. The arterial oxygen saturation has risen from 86 to 90 per cent. A plea is made to expand the indications for orthoterminal correction to patients in whom the severity of the heart malformation precludes application of well-established methods of surgical repair.

Since 1964, 90 patients have undergone two-stage surgical repair of ventricular septal defect (VSD) with pulmonary artery banding (PAB) in early infancy and total repair at an average age of 4 years. Reconstruction of the pulmonary artery was accomplished with a pericardial patch, woven Dacron patch, or transverse angioplasty. The VSD was closed with a knitted Dacron patch in 75 patients and by primary suture technique in 13 patients. The VSD closed spontaneously in 2 patients. The mortality rate for patients who had repair and debanding was 9 per cent (8 patients), including 4 deaths due to severe pulmonary hypertensive disease, 3 from congestive heart failure, and one from atrioventricular block. Twenty patients underwent repeat cardiac catheterization several months to 7 years after total repair. This study revealed no shunt in 16 patients and a minimal shunt not requiring operation in the other 4 children. Slight residual stenosis of the pulmonary artery was found in 2 patients and a residual infundibular stenosis in another 2 patients. We believe two-stage surgical treatment of VSD in severely ill infants under one year of age is safe and reliable.