Arterial switch operation in children with interrupted aortic arch: long-term outcomes.

have reported minimally invasive VATS using ECMO. The use of ECMO, however, has a potential problem with bleeding, especially when pleural adhesion exists. In the present case, we selected VATS under local and epidural anesthesia with preparation of ECMO, expecting less bleeding during the operation and early recovery after the operation. The procedure was well tolerated and the air leakage was completely controlled. The patient was discharged on day 4 after the operation. VATS procedures under local and epidural anesthesia have been reported in patients with spontaneous pnemothorax and secondary pneumothorax after lung transplantation. In a small randomized study, Pompeo and collegues reported that awake VATS bullectomy with pleural abrasion for spontaneous pneumothorax was feasible and provided equivalent outcome to procedures with the patient under general anesthesia. Thoracoscopic operations with the patient awake, however, have limitations. First, effective epidural anesthesia is indispensable and general anesthesia has to be induced when effective analgesia cannot be obtained. Second, total lung collapse cannot be obtained, especially in patients with limited contralateral pulmonary function, and thus lesions close to the hilum would not be adequately treated. Bearing these limitations in mind, we