We present the case of a 9-year-old girl with a distal aortopulmonary window (APW) with anomalous origin of right coronary artery from the main pulmonary artery and an isolated left subclavian artery arising from the main pulmonary artery. This report highlights the unusual combination of the three anomalies and late presentation of APW.

Percutaneous interventions have become significant in the management of congenital heart diseases, with transcatheter procedures being increasingly used for valve dysfunction, particularly for cases requiring repetitive surgeries. This abstract presents a successful transcatheter valve-in-valve implantation in a 16-year-old patient with severe tricuspid regurgitation following a bioprosthetic tricuspid valve replacement. The procedure involved transcatheter tricuspid valve implantation using the Mammoth 25x40 mm balloon catheter and the 26 mm Myval transcatheter heart valve system (Meril Life Sciences Pvt. Ltd, Vapi, Gujarat, India), resulting in immediate improvement in right atrial pressure and regurgitation. The patient underwent an electrophysiological assessment as part of the follow-up and was discharged with a normal sinus rhythm. Tricuspid valve interventions, although less common, are essential in congenital heart diseases, which necessitate prosthetic heart valve implantation due to long-term complications. The valve-in-valve procedure offers a safe alternative, especially in paediatric patients, for reducing risks caused by repetitive surgeries, providing a valuable treatment option in experienced centres.

Hyperlactatemia is a common and concerning finding in the paediatric cardiac ICU as it may signify tissue hypoperfusion and/or hypoxia. However, it is important to include other aetiologies for an elevated lactate in the differential, especially when the lactate is significantly elevated (> 8 mmol/L). We present the case of metabolic acidosis with severe hyperlactatemia secondary to Warburg effect and presumed thiamine deficiency in a paediatric heart transplant patient with post-transplant lymphoproliferative disorder.

We describe a trisomy 21 patient with postnatal diagnosis of atrioventricular septal defect with isolated ventricular component who had a complicated post-surgical course following complete repair. Clinical outcomes included moderate-severe residual atrioventricular valve regurgitation needing re-operation, complete heart block leading to pacemaker insertion, seizures secondary to subdural haemorrhages, and chylothorax. We describe the surgical considerations specific to this cardiac morphology.

Atrial myxoma in children is rare, with vision loss and cerebral metastasis seldom reported. We present the case of a 12-year-old girl who experienced sudden vision loss and acute infarction, with a left atrial myxoma identified and surgically resected. One year later, she was readmitted with severe neurological symptoms. Imaging revealed multiple hypometabolic brain lesions, which were confirmed as metastatic myxoma through surgical resection and pathology. This case underscores the critical need for long-term follow-up in patients with cardiac myxoma to monitor potential delayed neurological complications.

Premature atrial complexes are frequent among patients after heart transplantation. We herein report on the successful use of ivabradine in a 15-year old patient who exhibited marked palpitations caused by atrial premature complexes after orthotopic bicaval heart transplantation.

After right ventricular outflow tract obstruction reconstruction for CHD, surgical pulmonary valve replacement, or transcatheter pulmonary valve replacement may be performed if complicated by moderately severe or severe right ventricular outflow tract dysfunction. However, for patients whose anatomy is not suitable for transcatheter pulmonary valve replacement, surgical pulmonary valve replacement is the only option, but it has a higher rate of perioperative complications and longer hospitalisation for patients. In two cases of severe transcatheter pulmonary valve replacement in which percutaneous pulmonary valve implantation could not be performed directly due to the presence of a large right ventricle, a significant decrease in right ventricular function, and significant widening of the pulmonary arteries, we used a new hybridisation procedure to partially fold and reduce the diameter of the significantly widened pulmonary artery trunk without cardiopulmonary bypass by surgically opening the thorax in a median way, and then successfully implanted a percutaneous self-expanding pulmonary valve valve, with good immediate results in the postoperative period. The postoperative recovery was rapid and the recent results were excellent.

Middle aortic syndrome is rare cause of secondary hypertension, typically manifesting in childhood or early adolescence. It involves obstructive narrowing of the aorta, often occurring in the distal thoracic and abdominal aorta and its major branches. While the exact cause of middle aortic syndrome is not fully understood, it has been linked to hereditary genetic conditions such as Williams syndrome. This case report describes a 16-year-old female with Williams syndrome who presented with abdominal pain and hematochezia. CT angiography revealed moderate narrowing of the abdominal aorta, consistent with a diagnosis of middle aortic syndrome.

A preterm newborn (36 weeks, 2000 g) was diagnosed with hepatic hemangiomas during routine screening. Echocardiography revealed cardiac hemangiomas and pericardial effusion, requiring drainage. Propranolol was initiated for hepatic involvement. Over three years, cardiac and hepatic hemangiomas regressed without complications. This rare coexistence highlights the importance of multidisciplinary management and long-term follow-up.