A 10 years old boy with history of a heart surgery since the age of 1 year. By examination a mid sternotomy scar was seen, there was moderate central cyanosis and clubbing, there was also a harsh mid-systolic murmur heard allover the pericordium. Here is his echocardiogram attached. Could you help me to answer these questions:

1) What is your diagnosis ?

2) What is the flow seen around the aortic arch ?

3) What was the surgery done ?

4) What is the best way to manage him right now ?