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Descending thoracic aortobifemoral bypass via novel anterior subcutaneous tunnel approach was evaluated in 31 patients. Indications for this approach were; infrarenal aortic block with no site for infrarenal aortic clamping(18 cases), calcified infrarenal aorta(11 cases) and history of laparotomy(2 cases). Duration of surgery was 1.5 to 3 hours and blood loss was 300ml to 1000ml. There was mortality of 2 patients. Reexploration due to bleeding was done in 3 patients and 3 patients required prolonged ventilatory support for 2 days. This approach is recommended in selected patients where conventional approach to the abdominal aorta is not feasible. Follow up of 27 pateints had patent grafts in 24 patients and blocked grafts with no symptoms in 3 patients. 2 patients were lost to follow up.

Tetrology of fallot is the most common cause of cyanotic congenital heart disease with an incidence of 6-10 % among all congenital heart diseases. The anatomic defect comprising this entity leads to poor oxygenation resulting in symptoms of cyanosis, polycythemia and hypoxia. Most untreated patients die during childhood. Surgical treatment is the treatment of choice even during infancy. Many cardiac and extracardiac anomalies are associated with this entity. Here we report a 10 year old female patient of Tetrology of Fallot associated with double superior vena cava and absent right pleura. Total correction was made and the postoperative course was uneventful.