A four-month-old infant with severe congenital aortic stenosis underwent successful percutaneous transcatheter balloon valvuloplasty. While initially stable, ventricular bigeminy was detected at six-week follow-up, likely due to post-procedural myocardial inflammation. The arrhythmia resolved spontaneously by 12 weeks. This case highlights the need for vigilant post-percutaneous transcatheter balloon valvuloplasty monitoring to detect and manage late-onset arrhythmic complications.

Management of infants with hypoplastic left heart syndrome is resource-intensive. Trends in initial Stage 1 palliation choice and associated hospital cost and outcomes over time are unclear.Using a retrospective cohort of infants <30 days of age (2004-22) from the Paediatric Health Information Systems database, we analysed the annual prevalence of Stage 1 palliation choice, as well as the association between palliation choice and outcomes and resource use. Prevalence of palliation choice was calculated, and Mann-Kendall tests evaluated linear trends. Study outcomes were pooled across years and compared by palliation choice. Associations over time between palliation choice and outcomes and resource use were evaluated with generalised linear mixed models.Of 7701 patients, 67.45% (n = 5194) underwent a Norwood with modified Blalock-Taussig shunt, (NmBT) 22.06% (n = 1699) underwent a Norwood with right ventricle to pulmonary artery conduit (NRVPA), and 10.49% (n = 808) underwent a hybrid procedure. The annual prevalence of NRVPA surpassed that of NBT in 2017. In the pooled analysis, infants undergoing NRV-PA had the lowest in-hospital mortality (11.2%, P < 0.0001) and lowest cost at $335,406 (IQR: $208,624 to $583,322 (P = 0.001). A trend for increased median estimated hospitalisation cost was observed across time for all procedure choices (P for trend <0.0001 for all).These data suggest that the NRV-PA is the preferred palliation choice, has the lowest in-hospital mortality, and is the most cost-effective option. Our findings suggest that all Stage 1 palliation options have become more expensive with no observed change in mortality.

A male infant with fetal hydrops was diagnosed with congenital dilated cardiomyopathy and died at 2 months despite intensive treatment. Trio-exome sequencing identified as de novo FHL2 variant (p.Arg131Cys). He also presented with non-cardiogenic cholestatic liver injury and hyperferritinemia, which may represent novel FHL2-related phenotypes based on supporting evidence from experimental models.

We present six paediatric patients with unilateral absence of the pulmonary artery in pursuance of rising the clinician's recognition. Unilateral absence of the pulmonary artery was misdiagnosed in one patient by echocardiography. One patient had corrective surgery of a complete atrioventricular septal defect, and another had a right lobectomy. The remaining patients did not undergo any intervention and were asymptomatic at the end of the study period. Although there is a lack of consensus regarding optimal surgical approach, we opted for a more conservative strategy with good results.

Radiofrequency catheter ablation of ventricular arrhythmias, originating from the left ventricular summit, is challenging due to epicardial localisation of the substrate, surrounded by coronary arteries. This paper highlights the successful elimination of LVOT summit ventricular arrhythmia which was ablated from the aortic cusp and aortic mitral continuity in two paediatric patients. Ventricular tachycardia arising from the basal region of the left ventricular summit was identified in two male patients aged 9 and 13 years. Electroanatomic mapping of ventricular arrhythmia revealed the earliest ventricular signal within the left coronary artery which was successfully ablated from the left coronary cusp. The second patient with exactly similar ECG of ventricular arrhythmia was treated by delivering energy to the aorta-mitral continuity beneath the aortic valve. No recurrences were observed during the follow-up period of 20 months. Ventricular tachycardia arising from the basal region of the left ventricular summit is very rarely observed in paediatric patients. Utilising radiofrequency catheter ablation in proximity to the source can effectively and safely eliminate tachycardia.

Fontan conduit stenosis can impair haemodynamics, necessitating stent implantation. We present a 16-year-old patient who developed platypnea-orthodeoxia syndrome due to a post-stenting baffle leak. Despite initial diagnostic challenges, a second catheterisation confirmed and successfully sealed the defect with a covered stent. This case highlights the need for close monitoring and prompt intervention to manage complications in Fontan patients.

Children with CHD are at risk of neurodevelopmental impairment. Modifiable risk factors associated with hospitalisation that could impact neurodevelopment include being left alone for long periods of time with minimal interaction or opportunity to engage in developmentally appropriate play. Volunteers are an underutilised resource to help the medical team and families support neurodevelopment in cardiac care. Our Cardiac Inpatient Neurodevelopmental Care Optimization or CINCO team aimed to develop a volunteer programme specific to paediatric cardiac inpatient units. CINCO volunteers were recruited from the hospital volunteer pool and, in 2022, partnered with the University of Colorado to recruit health profession-interested students from under-represented backgrounds. All underwent hospital volunteer orientation and CINCO-specific training with cardiac child life, including education and shadowing. Volunteers completed an activity log and provided qualitative feedback. Between September 2021 and October 2024, 43 volunteers were onboarded and worked a total of 754 shifts. There were 2310 patient interactions, with an average of 3 patients seen per shift. Volunteers held patients 1231 times, played with patients 1230 times, and read to patients 780 times. A dedicated cardiac volunteer programme is a feasible, low-cost, and low-risk way to enhance neurodevelopmental care for inpatient children with CHD. When parents or caregivers are not present, volunteers participate as therapy extenders and may offset the care burden for nurses. Furthermore, allowing parents breaks may support their mental health, and increasing neurodevelopmental stimulation through volunteer interactions may mitigate disadvantageous aspects of a hospitalisation for neurodevelopment.

Coronary anomalies are a rare but potentially fatal congenital defect. Among high-risk anatomic features, totally anomalous origin of the coronary arteries from the pulmonary trunk is extremely rare, with only 57 cases reported in the literature as to our knowledge. We report a case of such a congenital anomaly with a successful surgical repair and good cardiac function recovery. We emphasise the need for awareness, since this anatomic presentation precludes collateral development and has, therefore, a higher mortality rate.

Neonates with ductal-dependent CHD rely on the patency of the ductus arteriosus to maintain circulation. Alprostadil is utilised to maintain ductal patency, although optimal dosing has not been determined. This study aims to describe alprostadil dosing in neonates with ductal-dependent CHD. This is a single-centre retrospective study including neonatal patients with ductal-dependent CHD who received alprostadil from January 2015 to December 2015 (cohort 1) and January 2021 to December 2021 (cohort 2). The primary objective was to describe alprostadil dosing in the two study periods. Secondary objectives included clinical outcomes and adverse events associated with different alprostadil dosing strategies. Sixty-five patients met eligibility for inclusion in this study: thirty-eight patients in cohort 1 and twenty-seven patient s in cohort 2. Baseline demographics were similar between cohorts. Initial alprostadil dosing in cohort 1 and cohort 2 was 0.006 mcg/kg/min and 0.025 mcg/kg/min (p = < 0.001), respectively. Patients in cohort 2 were found to have a higher incidence of apneic events, apneic events requiring respiratory support, and the incidence of fever ≥38 °C. In this single-centre study, we report that higher doses of alprostadil were associated with an increased risk of adverse events, which should be validated by prospective multicentre studies.