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Congenital heart surgery is one of the most demanding subspecialities in surgery. To become a competent surgeon, a lot of investment of time, in-depth study, training under a committed mentor, acquisition of the necessary fine surgical skills, and development of a three-dimensional appreciation of corrections are needed to be cultivated. These make it not only a speciality of skills, but also a cerebral speciality. It is commonly felt amongst the residents training in cardiovascular and thoracic surgery that they perform far less operative work to make them even "somewhat" confident of doing procedures independently towards the end of their residency. If this young cardiac surgeon needs to subspecialize in congenital heart surgery, more exposure to newer concepts and a much higher level of skill-based training become mandatory for achieving competence. Taking all this into consideration, this article will dwell on some of the traits and abilities that are desired in the candidates choosing to train in congenital heart surgery (CHS), the requirements of the speciality, and some tips to the trainers/mentors to help in effective devolution of thoughts, principles, and skills. Salient points of the mentoring process have also been discussed. A modular plan for staged acquisition and transmission of surgical skills, as well as surgical management of common congenital cases, has been outlined. Finally, a note is added to sensitize the young congenital heart surgeon to learn to embrace the nuances of practicing this speciality in India. This could also apply to many other developing and low- and middle-income countries.

An aortopulmonary window is known to be associated in 5% of interrupted aortic arch cases. The combination of these lesions with a bovine-type aortic arch is much more uncommon. We report its embryological explanation and successful single-stage surgical repair in a three-month-old infant.

INTRODUCTION: Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same. METHODS: We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients. RESULTS: A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%. CONCLUSION: In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.

A 14-day-old neonate presented with severe left ventricular outflow tract obstruction (LVOTO) and type B interrupted aortic arch. The child underwent a neonatal Ross Konno with interposition graft for arch reconstruction.

Large databases give an insight into patient characteristics and outcomes of patients undergoing coronary artery bypass grafting (CABG) in western populations. However, there is paucity of data in Indian population. This study was designed to understand the clinical characteristics and short-term outcomes of patients undergoing CABG at our institute. All the patients who underwent isolated CABG from January of 2001 to December of 2011 were included in the study. Those who underwent re-operative CABG and concomitant valve surgery were excluded. A total of 4,024 patients underwent CABG during the 11-year period. Mean age of patient population was 57 ± 9.6 years. The incidence of female patients undergoing surgery was 12.6 %. Diabetes mellitus was present in 58.4 % of patients. A total of 1,972 (49 %) patients had prior myocardial infarction. Thirty percent of patients had anterior and anterolateral wall infarction. Nineteen percent of patients had inferior wall infarction; 10.6 % had ischemic cardiomyopathy. Incidence of significant left main disease was 10.9 %. Majority of patients (66.4 %) presented with triple vessel disease. Ninety patients (2. 23 %) died in the early post-operative period. Post-operative stroke rate was 0.15 %. Acute renal failure requiring dialysis and mediastinitis occurred in 0.5 and 0.75 % of patients, respectively. Compared to Western population, this cohort of patients who underwent coronary artery bypass grafting had higher incidence of diabetes mellitus and ischemic cardiomyopathy and low incidence of significant left main disease. Post-operative stroke rate was significantly lower compared to 1–2 % stroke rate reported in western population.

Multiple muscular ventricular septal defects remain a challenge for the congenital heart surgeon. The optimal strategy for an infant or neonate with multiple muscular ventricular septal defects is still unclear. Perioperative identification and secure closure of these defects pose significant difficulties. We describe a novel technique of using fluorescein dye to identify small muscular ventricular septal defects.