Studies assessing the effect of preoperative iron supplementation in paediatric cardiac surgery are limited and yield conflicting data. The study aimed to evaluate the effect of preoperative oral iron supplementation on allogeneic blood transfusion after cardiac surgery for acyanotic CHD. This was a prospective, open-label, outcome assessor-blinded, randomised clinical trial performed in a large tertiary care centre in India. Children (haemoglobin <13 gm/dl) with acyanotic CHD were recruited for the study. Children in the intervention arm received colloidal iron (3 mg/kg), folic acid, and cyanocobalamin according to body weight for at least 7 days before cardiac surgery. The primary outcome was the amount of allogeneic blood transfusion, while secondary outcome measures were the duration of mechanical ventilation and ICU stay. A total of eighty-six children (43 in each arm) completed the trials. A total of 43 children received iron supplementation for a minimum of 1 month. The haemoglobin level improved by 1.3 gm/dl immediately before the cardiac surgery in the intervention arm. The allogeneic blood transfusions (ml/kg) median (IQR) were significantly lower in the intervention group (5 (0–8) vs 10 (8–12); p < 0.01). Furthermore, total cumulative allogeneic blood transfusion was also significantly lower in the intervention arm (60 ml; (0–100) vs 100 ml; (70–140); p < 0.001). The duration of mechanical ventilation, ICU stay, and hospital stay was significantly lower in the intervention arm. Preoperative oral iron supplementation significantly reduces the need for allogeneic blood transfusion in children undergoing cardiac surgery for acyanotic heart disease.

Infants with single ventricle CHD commonly experience gross motor delays due to physiological and environmental factors, including increased risk for white matter injury, reduced aerobic capacity, restrictive post-operative protocols, and limited movement opportunities. These delays persist in adolescence, affecting physical and social development. This study examines a quality improvement initiative within the National Pediatric Cardiology Quality Improvement Collaborative to enhance gross motor development. Fifteen centres participated. Gross motor skills were assessed using the Ages and Stages Questionnaires, Third Edition, at 6 and 12 months. A key driver diagram, Plan-Do-Study-Act cycles, baseline data, and ongoing process measures were collected. Interventions were implemented, including education, therapy support, and mobilisation protocols. Control charts were used to evaluate the data. Scores from the Ages and Stages Questionnaires indicated delays in gross motor skills at baseline, with improvement over time. Participating centres showed a centerline shift from 41% to 89% of infants achieving on-target or improved motor scores, compared with 54% to 68% of infants at non-participating centres. Establishment of customised infant developmental plans increased from 62% to 74% for participating centres and from 53% to 61% for non-participating centres. Interventions included establishing processes for consistent screening, developmental plan administration, review of prone positioning, access to therapies, and early intervention referrals. This targeted quality improvement project increased the use of inpatient practices to support gross motor development for infants with single ventricle CHD. Collaborative, interdisciplinary efforts remain critical for addressing neurodevelopmental challenges in this high-risk population.

Chylothorax and chylopericardium are rare in children and are typically associated with cardiothoracic surgery, congenital lymphatic abnormalities, or malignancy. Traumatic chylous effusions are particularly uncommon. We report an 11-year-old boy who developed extensive cervical and upper chest swelling following a minor firecracker blast injury. Subsequent imaging revealed large chylous pleural and pericardial effusions. Persistent high-output chyle loss despite exhaustive conservative therapy necessitated thoracic duct embolisation, which successfully resolved the effusions. This case highlights the importance of considering lymphatic injuries following seemingly trivial trauma and demonstrates the utility of percutaneous thoracic duct embolisation in paediatric lymphatic leaks.

The KONAR-MF™ occluder, with its flexible medium-profile design, has broadened the feasibility of transcatheter closure of muscular ventricular septal defects, particularly in infants. To assess feasibility, safety, techniques, and outcomes of muscular ventricular septal defect closure using the KONAR-MF™ occluder in a multicentre paediatric cohort. A retrospective review was conducted at three tertiary paediatric cardiac centres (2018-2024). Patient demographics, ventricular septal defect characteristics, procedural approaches, and follow-up outcomes were analysed. Device implantation was performed via retrograde, antegrade, transseptal, or hybrid approaches under fluoroscopic and echocardiographic guidance. Fifty patients (54 devices) were included (median age: 48 months [interquartile range 12-96]; weight: 12 kg [interquartile range 7.5-23]), including 14 infants (9 < 7 kg). Indications were failure to thrive (46%), heart failure (28%), recurrent infections (12%), and postoperative residual ventricular septal defect (14%). The mean ventricular septal defect size was 5.8 ± 2 mm. Median fluoroscopy time was 18 minutes (range: 3-71). Residual shunts were present in 18% immediately, reducing to 9% at one week and resolving by three months. Mild, transient tricuspid regurgitation occurred in 14%. Over a median 9-month follow-up (range 1-60), no cases of heart block or haemolysis occurred. One embolisation required surgical retrieval. Pulmonary artery pressure decreased significantly (37 ± 13.4 to 19 ± 3.8 mmHg, p < 0.001). Transcatheter closure of muscular ventricular septal defects with the KONAR-MF™ occluder is safe, effective, and versatile across paediatric age groups, including infants and postoperative cases. High success rates, minimal complications, and favourable short- to mid-term outcomes support its use in routine practice.

Aerococcus urinae, a gram-positive bacterium found in 0.25-4% of urinary samples, is increasingly recognised as a cause of invasive urinary tract infections and bacteraemia. Its true prevalence is likely underestimated due to misidentification as other gram-positive cocci. Advances like matrix-assisted laser desorption ionisation time-of-flight mass spectrometry have improved diagnostic accuracy. Though rare, A. urinae infective endocarditis is being reported more frequently, especially in adults with cardiac and urinary tract abnormalities. Paediatric cases are uncommon but can be severe. We report a case of mitral valve infective endocarditis in a 15-year-old female with congenital heart defects and neurogenic bladder, presenting with embolic stroke. This highlights the need for prompt diagnosis and multidisciplinary management to improve outcomes in this rare but serious condition.

Cardiopulmonary bypass-induced inflammation is associated with poor postoperative outcomes. Bypass exposure has been associated with shifts in lymphocyte populations. This study aimed to describe two cytokine profiles associated with T and NK cells and their effects on clinical markers of postoperative cardiovascular dysfunction in children undergoing cardiac surgery with cardiopulmonary bypass. Children from two major children's hospitals undergoing corrective cardiac surgery with cardiopulmonary bypass were included. Plasma was collected pre-, 0 to 4 hours post- and 24 hours (when available) postoperatively. Plasma concentrations of cytokines were quantified using enzyme-linked immunosorbent assays. Delta cytokine concentrations were compared to vasoactive infusion score and percent fluid balance on postoperative day one. Vascular reactivity was assessed in a subset of the cohort. Confirmation of endothelial-specific effects of interferon-γ and interleukin-17A was performed in microvascular endothelial cells, assessing cytokine levels by enzyme-linked immunosorbent assays or trans-endothelial electrical resistance. A total of 26 children were included in the analysis. Interferon-γ was inversely associated with vasoactive infusion score (p < 0.05), whereas interleukin-17A and interleukin-23 were associated with greater cumulative postoperative fluid balance (p < 0.01 and 0.03, respectively). Peak vascular reactivity is strongly associated with interferon-γ (p = 0.001), but not with circulating interleukin-17A. Human microvascular endothelial cell exposure to interferon-γ increased endothelial permeability and cytokine production. Interferon-γ and interleukin-17A may be associated with cardiovascular dysfunction in children after exposure to cardiopulmonary bypass, albeit with differential clinical features. Interferon-γ may directly impact vascular measures, while the impact of interleukin-17A may relate to fluid accumulation.

Infective endocarditis remains a serious condition. Patients with CHD are particularly susceptible due to structural abnormalities and repeated interventions. However, comparative data on infective endocarditis outcomes in patients with and without CHD stratified by age group remain limited. We searched PubMed, Embase, and Cochrane for cohort studies comparing infective endocarditis outcomes in CHD versus non-CHD. Risk ratios with 95% confidence intervals were pooled using random-effects models. We included six observational cohort studies encompassing 180,194 patients, of whom 176,882 were adults and 3312 were children. Overall, 65% of the population were male. Patients with CHD tended to be younger and carried a lower comorbidity burden. CHD was associated with lower in-hospital mortality risk in adults (RR 0.42; 95% CI 0.34-0.53; p < 0.01), whereas children with CHD demonstrated higher risk (RR 1.59; 95% CI 1.08 to 2.32; p = 0.02). Streptococcus infective endocarditis was more common in adults with CHD (RR 1.28; 95% CI 1.09 to 1.50; p < 0.01), while Staphylococcus aureus infective endocarditis was less common in both adults (RR 0.71; 95% CI 0.58 to 0.88; p < 0.01) and paediatric (RR 0.73; 95% CI 0.64 to 0.84; p < 0.01) CHD patients. In this meta-analysis, mortality patterns in CHD varied by age, with lower mortality in adults and higher mortality in children. Streptococcus infective endocarditis was more common in adults with CHD, whereas Staphylococcus aureus was less frequent across CHD age groups. These results highlight the need for age-specific and individualised endocarditis management in CHD.

We present the case of an 8-year-old male with frequent premature ventricular contractions and mild left ventricular dysfunction, who was found to carry heterozygous variants in both FLNC and CTNNA3. Medical therapy resulted in improved systolic function and reduced arrhythmia burden. This rare combination suggests a potential genotype-phenotype correlation in paediatric arrhythmogenic cardiomyopathy.

Anomalous aortic origin of the right coronary artery poses serious risks when involving high-risk features such as a long intramural course or a slit-like orifice, with demand ischaemia as the likely pathophysiology of sudden cardiac arrest. This case links sudden cardiac arrest to demand ischaemia, confirmed by cardiac MRI showing a transmural infarct in the right coronary artery territory. This is a rare case demonstrating transmural infarction in a patient with an anomalous aortic origin of the right coronary artery, as demonstrated by cardiac MRI findings.

Hearts with a double-inlet and double-outlet right ventricle are infrequent. Due to their infrequency, it is unclear whether there are natural patterns in hearts like this. A systematic review was performed to identify published cases of double-inlet double-outlet right ventricle. Characteristics for individual reported hearts were collated and entered into a cluster analysis. Hearts with double-inlet, double-outlet right ventricles tended to fall into two clusters largely based on aortic atresia and systemic venous connections.