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OBJECTIVES Tetralogy of Fallot (TOF) with hemitruncus (HT) is a rare entity. In this report, we present our experience with this condition over the last 20 years. METHODS Between January 1994 and June 2013, 11 patients with HT and TOF underwent surgery at the All India Institute of Medical Sciences, New Delhi, India. All available clinical, radiographic, echocardiographic, cardiac catheterization, operative and follow-up data were reviewed. RESULTS The mean age was 73 ± 7.1 months (range 7 months to 18 years) and the mean weight was 15.7 ± 1.2 kg. The mean preoperative saturation was 79.3 ± 11.7% (range 62–92%). Six patients had anomalous left pulmonary artery (PA), whereas 5 had an anomalous right PA arising from the aorta. Surgical procedures consisted of complete intracardiac repair of TOF with direct implantation of the anomalous PA into the main PA (n = 7), intracardiac repair of TOF with an interposition saphenous vein graft between the right PA and main PA (n = 1), and reconstruction of the left PA with autologous pericardium with intracardiac repair of TOF (n = 1), direct implantation of the anomalous PA into the main PA with an innominate to right pulmonary artery shunt (n = 1) and a right PA banding with innominate to left PA shunt (n = 1). There were two early deaths. Follow-up ranged from 3 to 73 months. All survivors are in NYHA Class I and follow-up echocardiograms did not show any residual lesions. CONCLUSIONS Surgical repair of HT with TOF results in acceptable early outcomes. The surgical strategy needs to be individualized to the anatomy of the patient. [ABSTRACT FROM AUTHOR]

Background: Subaortic membrane (SAM) is a form of fixed subaortic obstruction in which a fibrous membrane is located below the aortic valve. Aim: To determine the role of surgical treatment for patients with a discrete SAM. Patients and Methods: The hospital records of 45 patients (age range: 2–23 years; median 8 years) undergoing surgery for SAM between 1990 and 1998 at the All India Institute of Medical Sciences, New Delhi, India, were analysed. Preoperative echocardiographically calculated gradients across the left ventricular outflow tract ranged from 50 to 154 mmHg (mean: 86.5 ± 33.2 mmHg). Nine patients had trivial aortic regurgitation (AR), 10 had mild AR and five had moderate–severe AR. The left ventricular ejection fraction (LVEF) ranged from 20 to 68% (mean 48 ± 15%). Nineteen patients had significant left ventricular dysfunction (LVEF <50%). Transaortic resection of SAM was done in all patients along with excision of a wedge-shaped segment of septal muscle underlying the membrane. Results: There were no early or late postoperative deaths. On follow up (up to 113 months), only four patients had gradients >30 mmHg. LVEF improved to 45–70% (mean 58 ± 7.7%). AR reduced to mild in four patients and trivial in four patients, and did not progress further. Conclusion: Resection of SAM carries long-term benefits. Routine septal myectomy appears to be associated with a low risk of recurrence. (Heart, Lung and Circulation 2001; 10: 130–135). [ABSTRACT FROM AUTHOR]