Type A3 truncus arteriosus describes pulmonary atresia with non-confluent mediastinal pulmonary arteries in which one pulmonary artery arises from a patent ductus arteriosus and the contralateral pulmonary artery from the aorta resulting in ductal dependent pulmonary blood flow. We describe a premature neonate with caudal regression syndrome and type A3 truncus arteriosus who was palliated with a ductal stent allowing completion of a prolonged neonatal ICU hospitalisation for multiple comorbidities.

Diagnosing prosthetic valve infective endocarditis in children is challenging. Transthoracic and transesophageal echocardiography can yield false-negative results. Data are lacking in paediatric multimodality imaging in prosthetic valve infective endocarditis. We present two children with repaired CHD where initial echocardiogram was non-diagnostic, while CT angiogram and 18F-fluorodeoxyglucose positron emission tomography in combination with CT angiography, respectively, confirmed the diagnosis of endocarditis affecting clinical management.

We present a case of a 3-week-old boy with persistent truncus arteriosus associated with interrupted right aortic arch having an anomalous origin of the left vertebral artery from the ascending aorta.

Introduction: Canadian stroke best practice guidelines recommend patients suspected of Acute Cerebrovascular Syndrome (ACVS) receive urgent brain imaging, preferably CTA. Yet, high requisition rates for non-ACVS patients overburdens limited radiological resources. We hypothesize that our clinical prediction rule (CPR) previously developed for diagnosis of ACVS in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. Methods: Our data consists of records for 1978 ED-referred patients to our TIA clinic in Victoria, BC from 2015-2016. Clinic referral forms captured all data needed for the CPR. For patients who received CTA, orders were placed in the ED or at the TIA clinic upon arrival. We use McNemar’s test to compare the sensitivity (sens) and specificity (spec) of our CPR vs. the baseline CTA orders for identifying ACVS. Results: Our sample (49.5% male, 60.6% ACVS) has a mean age of 70.9±13.6 yrs. Clinicians ordered 1190 CTAs (baseline) for these patients (60%). Where CTA was ordered, 65% of patients (n=768) were diagnosed as ACVS. To evaluate our CPR, predicted probabilities of ACVS were computed using the ED referral data. Those patients with probabilities greater than the decision threshold and presenting with at least one focal neurological deficit clinically symptomatic of ACVS were flagged as would have received a CTA. Our CPR would have ordered 1208 CTAs (vs. 1190 baseline). Where CTA would have been ordered, 74% of patients (n=893) had an ACVS diagnosis. This is a significantly improved performance over baseline (sens 74.5% vs. 64.1%, p<0.001; spec 59.6% vs. 45.9%, p<0.001). Specifically, the CPR would have ordered an additional 18 CTAs over the 2-yr period, while simultaneously increasing the number of imaged-ACVS patients by 125 with imaging 107 fewer non-ACVS patients. Conclusion: Using ED physician referral data, our CPR demonstrates significantly higher sensitivity and specificity for CTA imaging of ACVS patients than baseline CTA utilization. Moreover, our CPR would assist ED physicians to apply and practice the Canadian stroke best practice guidelines. ED physician use of our CPR would increase the number of ACVS patients receiving CTA imaging before ED discharge (rather than later at TIA clinics), and ultimately reduce the burden of false-positives on radiological departments.

Introduction: It remains unclear whether widespread use of computed tomography angiography (CTA) in acute strokes and transient ischemic attacks (TIAs) has tangible benefits for patient outcomes or management. We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) investigating the use of CTA and patient-important outcomes (recurrent stroke, mortality, disability, and emergency department (ED) revisits) or changes in management in patients presenting with acute stroke or TIA. PROSPERO: 349590 Methods: MEDLINE, EMBASE, and the Cochrane Registry were searched through May 24, 2016 for eligible trials. We included observational cohort studies and RCTs evaluating use of CTA against a control group for outcomes of interest in patients presenting acutely with suspected stroke or TIA. Two independent reviewers extracted data and assessed study quality using the Newcastle Ottawa Scale. Data for mortality and stroke rate were pooled by the generic inverse variance method and expressed as risk ratios (RRs) with 95% confidence intervals (95% CI). Data for disability were reported as the mean difference (MD) and 95% CI. Heterogeneity was assessed using the Cochran’s Q statistic and quantified by the I2 statistic. Overall strength of the evidence was assessed by the GRADE approach. Results: Three observational cohort studies involving 979 patients over an average of 1 year follow up met inclusion criteria; there were no eligible RCTs. CTA use in acute stroke or TIA patients was associated with a decreased mortality rate (RR=0.55, 95% CI 0.33 to 0.91, P=0.02; Phet=0.88, I2=0%). No changes were detected in stroke rate (RR=0.84, 95% CI 0.40 to 1.73, P=0.63; Phet=0.79, I2=0%). One study with data for disability showed no changes in mRS (MD=0.01, 95% CI -0.70 to 0.73, P=0.97). There were no eligible studies with data for ED revisits or changes in management. The strength of the evidence was assessed as very low quality due to imprecision for mortality, stroke rate, and disability. Conclusion: CTA use was associated with significantly reduced mortality in acute stroke and TIA patients, possibly due to confounding from poor baseline status of patients not receiving CTA. No significant changes were found for stroke rate or disability. There is a need for RCTs to confirm the effects of CTA use on patient outcomes and management.