Paclitaxel-eluting balloons are a new and innovative method in the treatment of in-stent stenosis and small vessel disease in adult cardiac pathology. The treatment of congenital pulmonary vein stenosis is difficult to manage, and results in a high mortality rate due to residual or recurrent stenosis. We report the first case of treatment for neonatal pulmonary vein restenosis with a paclitaxel-eluting balloon.

In the United States of America, approximately 40,000 infants are born annually with congenitally malformed hearts. Children with defects that require complex surgical palliation, or definitive repair, face many challenges in achieving optimal short-term and long-term growth. The presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. In this review, we address three themes related to feeding, growth, and nutrition of infants after neonatal cardiac surgery: nutritional challenges after chylothorax; breastfeeding after surgery; and the challenges of feeding after discharge. Chylothorax is a rare complication following cardiothoracic surgery in children. Children with chylothorax have nutritional depletion secondary to protein losses in chylous fluid, hypovolaemia, and electrolyte losses. In spite of the evidence supporting the use of human milk and breastfeeding in preterm infants, barriers to its use appear to persist in infants with critical cardiac disease. Yet, human milk is the preferred form of nutrition for well, preterm, or ill infants. It is well documented that after complex neonatal cardiac surgery medical teams and families struggle with infant feeding problems. Parents have described feeding their children as difficult, time consuming, and anxiety producing. Medical complications such as chylothorax, limited access to human milk, and parental concerns and stress about feeding are but three of the myriad of factors that may contribute to poor outcomes regarding nutrition and growth. Compelling evidence exists that this multi-factorial problem must be addressed with both physiological and behavioural strategies.

Percutaneous pulmonary valve implantation for conduit dysfunction in the right ventricular outflow tract is a safe and efficient treatment in selected patients. We report on a patient with stenosis and regurgitation of a homograft in the right ventricular outflow tract who developed complete atrioventricular block during percutaneous implantation of a Melody™ valve. This complete atrioventricular block spontaneously reverted to a stable sinus rhythm after 3 weeks.

We present a case report of a pregnant woman with increased risk for trisomy 21 at first-trimester screening, assessed by ultrasonography, that was sent to our hospital. Amniocentesis was performed at 14 weeks and 2 days to obtain foetal karyotype that was normal (46,XX). At 19 weeks and 1 day, foetal hydrops associated with cardiac malformation was detected by routine scan. Foetal echocardiogram revealed a complete auriculoventricular septal defect, non-compacted myocardium, and a bradycardia of 70–90 beats per minute, which lead to the suspicion of left isomerism. Foetal death occurred at 20 weeks and 3 days. Autopsy was consistent with the prenatal diagnosis.

We performed pacemaker implantation with biventricular pacing using a usual dual-chamber pacemaker device in three children with complete atrioventricular block. The post-operative QRS durations were 114, 112, and 106 milliseconds in patients 1, 2, and 3, respectively. Post-operative echocardiography revealed well-synchronised left ventricles. Biventricular pacing in children with complete atrioventricular block may be useful for shortening the QRS duration.

We report our experience in a 12 year old boy referred with suspected myocardial infarction. He has previously been diagnosed with systemic lupus erythematosus, and was being treated with steroids. Echocardiographic examination revealed a thrombus in the left aortic coronary sinus of Valsalva partially occluding the orifice of the left coronary artery. The thrombosis was successfully treated by venous thrombolysis using recombinant tissue plasminogen activator.

Scimitar syndrome is a rare condition often with a separate systemic arterial supply from the abdominal aorta. Occlusion of this systemic arterial supply is frequently performed, though it can be difficult in small patients or in those with tortuous vessels. This case documents use of the new Amplatz vascular plug IV for arterial occlusion. It has major advantages in being able to deliver the device through a 4F catheter without the need to upsize to a dedicated delivery sheath. This is particularly appealing to paediatric practice or to those with difficult anatomy in older patients.

We describe a 6-year-old boy with newly diagnosed Costello syndrome after the diagnosis of severe hypertrophic cardiomyopathy. His neonatal asymmetric septal cardiomyopathy resolved by 9 months of age but reappeared at 6 years of age. This report highlights two important concepts: the association of genetic syndromes with hypertrophic cardiomyopathy and the possibility of worsening severity of hypertrophic cardiomyopathy linked to growth hormone therapy.

We report a development of severe haemolysis after complete transcatheter closure of patent arterial duct. Aortography and echocardiography revealed no signs of residual shunt. Haemolysis occurred a day after the implantation. Aortography was performed and the extrusion of coil in aorta was evident. The extruded part of the coil was surgically removed. No signs of haemolysis remained.

We report on a 37-year-old woman presenting with atrial arrhythmias after catheter closure of a secundum atrial septal defect with an Amplatzer septal occluder device. Eletrophysiological studies suggested that the arrhythmia originated from the left atrium, from an area near the device. Transseptal puncture was successfully performed under transoesophageal guidance and the arrhythmia was successfully ablated. This case showed that transseptal puncture can be safely performed in the presence of an Amplatzer septal occluder device under transoesophageal echocardiography guidance and we speculate that the device may have created the substrate for the arrhythmia.

The common respiratory syncytial virus has been associated with cardiac involvement, usually tachyarrhythmias and occasionally myocarditis. A child is described who probably developed a complete heart block following respiratory syncytial bronchiolitis. Such an association needs to be considered if the heart is structurally normal and there is no evidence of a congenital heart block in a setting of maternal anti-Ro and anti-La antibodies.

Here, we report an infantile case of ventricular septal defect and restrictive cardiomyopathy caused by a de novo mutation of the cardiac troponin T gene. Initially diagnosed with a perimembranous ventricular septal defect in the newborn period, we observed the first signs of restrictive cardiomyopathy at the age of 18 months. The patient was listed for cardiac transplantation at the age of 8 years despite optimal medical treatment. The finding of a de novo mutation in TNNI3 (R204H) enabled a genetic diagnosis and counselling. We suggest that the previously reported overlap of functional and morphologic phenotypes in sarcomeric genes may also be a feature of TNNI3 mutations.

In the early 1980s cardiology was dominated by “triple threat individuals” – doctors who were the very best clinicians, very best researchers, and very best teachers. This type of individual usually became the director of the division. Now, however, the amount of knowledge and specialisation in each of these three areas of expertise has exploded. It is not certain that triple threat individuals can or do exist today. Instead, we need to be aiming higher, for a “quintuple threat profession”. Not only do we need expertise in clinical care, teaching, and research, but also we now require business leadership and alignment. No single person can be expert in all five of these areas. In paediatric cardiology we need to invest in the right people. Our new “quintuple threat profession” needs to match the expertise and passion of the right people with our current and future needs. Going forward, we should focus on leadership, teams, and alignment. We need to identify, develop, and empower leaders at all levels within our profession, including physicians, nurses, and hospital administrators. Ultimately, we need a profession that remains clinically led, but professionally managed. The second step of the formula is the development of successful teams, and teamwork. Successful “team behaviour” is not a part of traditional medical education. The third step is alignment. Alignment can be defined as representing the degree to which physicians and organisations, such as hospitals, acting out of enlightened self-interest, operate inside a common vision, mutual goals, and the acceptance of a shared destiny. Imagine the benefits to our profession and our kids if we can provide a new level of leadership, teamwork, and alignment going forward.

We report a male child with haemophagocytic lymphohistiocytosis who developed myocardial infarction after receiving etoposide. He recovered well with supportive measures and after discontinuation of etoposide. We discuss the possible mechanisms and differential diagnoses of myocardial infarction in our patient.

We describe an atypical presentation of stress-induced cardiomyopathy – Takotsubo cardiomyopathy – in a 16-month-old boy previously diagnosed with cyclic vomiting and episodic hypertension. He developed features of cardiac failure and his echocardiogram showed left ventricular wall motion abnormality accompanied with elevated cardiac enzymes. Cardiac catheterisation showed no coronary arterial abnormality. Complete spontaneous recovery occurred 2 weeks after admission.