Rheumatic heart disease remains a leading cause of preventable cardiovascular morbidity and premature mortality among children and young adults in Sub-Saharan Africa. Advances in portable echocardiography, standardised World Heart Federation diagnostic criteria, and task-sharing strategies have substantially expanded the detection of latent rheumatic heart disease. However, increased diagnostic capacity has not consistently translated into improved long-term clinical outcomes. This viewpoint argues that the principal challenge in rheumatic heart disease control has shifted from underdiagnosis to the inability of health systems to provide sustained longitudinal care after screening. Although the GOAL Trial demonstrated that secondary prophylaxis with benzathine penicillin reduces echocardiographic progression of latent disease, robust evidence that screening alone decreases heart failure, stroke, need for valve surgery, or mortality remains limited. Furthermore, recurrent shortages of benzathine penicillin, fragmented follow-up, weak referral pathways, and socioeconomic barriers continue to undermine the effectiveness of screening programmes across Sub-Saharan Africa. We propose a paradigm shift in the evaluation of rheumatic heart disease screening initiatives: programme success should no longer be measured primarily by the number of cases detected but by the proportion of patients retained in continuous care and protected from major cardiovascular outcomes. Future rheumatic heart disease programmes should integrate early diagnosis with reliable access to secondary prophylaxis, structured follow-up, timely referral for specialist and surgical care, and outcome-based evaluation. Redefining screening success around care retention rather than diagnostic yield may substantially improve the long-term impact of rheumatic heart disease control strategies in resource-limited settings.

Term neonate with respiratory distress had a giant cystic intrapericardial mass causing cardiopulmonary compression and effusion. Echocardiography and chest tomographic defined the anatomy; surgical resection confirmed an immature pericardial teratoma with a favourable diagnosis.

Although well-described, there are few published images of spasm of major aortopulmonary collateral arteries in pulmonary atresia with ventricular septal defect. We offer here angiographic evidence of unprecipitated spasm affecting multiple vessels simultaneously.

Cinematic rendering is an advanced three-dimensional post-processing technique that applies Monte Carlo–based global illumination to CT datasets, producing photorealistic volumetric reconstructions that enhance depth perception and tissue-plane visualization compared with conventional greyscale imaging. In this pictorial essay, cinematic rendering was applied to coronary CT angiography examinations demonstrating anomalous coronary artery origins, including interarterial trajectories and post-surgical anatomy following unroofing procedures. Using illustrative cases, we describe how cinematic rendering’s depth cues and soft-tissue contrast can complement standard two-dimensional reconstructions when characterizing vessel course relative to the great vessels—an anatomic distinction relevant to risk stratification and surgical planning. These observations are qualitative and drawn from our experience with the cases presented rather than from a blinded reader study or quantitative comparison; we discuss this limitation further below. Through representative imaging examples, cinematic rendering helped reestablish volumetric context and enabled continuous tracking of coronary vessels in the cases presented.

Patent ductus arteriosus closure is usually straightforward, but prior surgical ligation may create barriers to device delivery. We describe a 1.5-month-old infant (2.9 kg) with Edwards syndrome, large ventricular septal defect, and clinically significant residual patent ductus arteriosus after pulmonary artery banding and surgical ligation. Catheterisation via 4F femoral venous access confirmed a 2.5 mm patent ductus arteriosus. An Amplatzer Piccolo Occluder 4/2 mm was planned, but delivery proved difficult. Three approaches failed: telescoping (0.014″ wire, Progreat 2.8F, and TorqVue 4F), wire escalation with multipurpose catheters and 0.018″/0.035″ exchanges, and a long 4F Flexor sheath. Obstruction at the patent ductus arteriosus level was consistent with suspected residual surgical ligature. As bailout, a 2.0 × 15 mm Ryurei coronary balloon was gently hand-inflated only to fill the TorqVue tip and used to advance the system across the obstruction. This enabled successful occluder deployment with complete closure. Residual patent ductus arteriosus after surgery may pose unique challenges; balloon-assisted sheath advancement is a simple and effective bailout when conventional techniques fail.

Cardiac point-of-care ultrasound may serve as a bedside screening tool for the early identification of left ventricular systolic dysfunction in children, but paediatric data remain limited in clinical practice. In a retrospective cohort study of children with multisystem inflammatory syndrome in children undergoing cardiac point-of-care ultrasound at presentation, qualitative assessments of left ventricular systolic function by credentialed paediatric emergency medicine physicians were obtained and demonstrated high sensitivity for detecting dysfunction across the spectrum of left ventricular systolic failure.

A 10-year-old girl who showed no abnormalities on resting or exercising stress electrocardiograms underwent Holter monitoring because of a family history of Brugada syndrome, which revealed marked QT prolongation during sleep. SCN5A-related inherited arrhythmia was suspected, and genetic testing confirmed the p.Glu1783Lys variant in SCN5A. Children with a family history of Brugada syndrome should undergo Holter monitoring proactively, suspecting the possibility of SCN5A-related inherited arrhythmia, even if 12-lead electrocardiograms show no abnormalities.

Children with single-ventricle post-Fontan palliation often struggle with chronic hypoxaemia and adverse neurodevelopmental outcomes. This brief report describes cardiorespiratory parameters obtained through polysomnography in 48 children and adolescents with Fontan circulation and investigates associations between polysomnography and neuropsychological testing in a subset of 26 patients. We found intermittent hypoxaemia was associated with parent-reported inattention symptoms, and severity of obstructive sleep apnoea with poorer visual-motor integration skills (all p < 0 .05). Prompt recognition and treatment of these modifiable risk factors may have the potential to improve neurodevelopmental outcomes and quality of life.

We have previously described how children with complex CHD access developmental and psychosocial services in Maine, most often beyond the reach of the surgical centre. In this follow-up study, we describe a similar pattern for children in Vermont. Of 406 at-risk children between 2017 and 2019, 37% had an encounter. Very few individuals underwent developmental assessment or psychological or neuropsychological testing (1–4%). Visit volume was highest for mental health assessments in children older than 5 years and occurred predominately in community clinics and private practices close to home.

The coexistence of absent pulmonary valve syndrome, Type B interrupted aortic arch, and severe aortic stenosis represents an exceptionally rare and complex congenital cardiac phenotype. The diagnosis was established in a newborn using multimodality imaging. Given the profound airway compression secondary to the massive pulmonary artery dilatation and the associated poor prognosis, palliative care was chosen.

Arteriovenous malformations of the head and neck are rare high-flow vascular lesions that present significant therapeutic challenges. We report a 9-year-old boy with a giant cervical arteriovenous malformation successfully treated by staged transcatheter embolisation using detachable coils alone. This case suggests that coil-only embolisation may be a safe and effective treatment option for carefully selected paediatric cervical arteriovenous malformations.

Right heart thrombus is rare and high-risk in paediatrics. A 14-year-old boy presented with dizziness and leg numbness. Imaging revealed mobile right ventricular thrombi and massive pulmonary embolism. Despite therapeutic anticoagulation, respiratory failure ensued. Emergency surgical thrombectomy and pulmonary endarterectomy were lifesaving. This case highlights that for high-risk right heart thrombi, multimodal imaging is key, and timely surgery is critical.

A boy with heart failure and mechanical pulsus alternans was treated with enalapril malate and carvedilol; however, left ventricular contraction did not improve. After treatment with ivabradine, the pulsus alternans disappeared, and left ventricle contraction improved. Thorough evaluation revealed an abdominal paraganglioma producing noradrenaline, and excision of the tumor normalised the left ventricle contraction. Catecholamine-induced cardiomyopathy caused by paragangliomas is an extremely rare but important differential diagnosis of dilated cardiomyopathy. Thus, ivabradine is a good candidate for the treatment of heart failure, even in the presence of catecholamine-producing tumours.

The coexistence of truncus arteriosus and tricuspid atresia is exceptionally rare. We report a preterm infant with truncus arteriosus, tricuspid atresia, and a hypoplastic right ventricle. Despite planned staged palliation, the infant died from complications of prematurity and sepsis. To our knowledge, this is the lowest birth weight infant reported with this combination.

Carvajal syndrome is a rare familial cardio-cutaneous disorder characterised by the triad of woolly hair, palmoplantar keratoderma, and dilated cardiomyopathy. It results from mutations in the DSP gene, (p 24) a desmosomal protein crucial for cell adhesion. Defective desmoplakin disrupts myocardial and epidermal integrity, leading to electrical and contractile dysfunction of the heart. The resulting cardiomyopathy progresses to life-threatening congestive heart failure. We describe a 7-year-old boy from Delhi, India, who presented with features of decompensated heart failure along with woolly hair and palmoplantar keratoderma. Genetic sequencing confirmed a homozygous DSP gene mutation with a novel variant, establishing the diagnosis of Carvajal syndrome. This case emphasises the importance of recognising dermatological manifestations as early warning signs of severe underlying cardiac disease.

Acute severe haemolysis following atrial septal defect(ASD) device closure is extremely rare, where precise incidence, underlying aetiologies, and optimal management strategies remain inadequately understood. We report a case of significant haemolysis after transcatheter atrial septal defect closure in 10 year old female, possibly related to the interface between the device surface and the high-velocity jet of valvular regurgitation resulting from the abnormal configuration of the device. The presence of a residual shunt, combined with atrioventricular valve regurgitation flow, places pressure on the occluder’s discs, leading to increased erythrocyte fragility and subsequent rupture. In our case, haemolysis was initially conservatively managed with fluids, diuresis, and sodium bicarbonate, and the patient was discharged successfully on the 6th post-procedure day. Surgical retrieval was advised; however, the patient was subsequently lost to follow-up. In this case report, we aim to showcase the pathophysiology, technical pitfalls regarding the procedure and management of acute severe haemolysis that occurred after atrial septal defect device closure. In conclusion, by sharing our clinical experiences and addressing misconceptions and potential risk factors for this serious complication, we aim to provide insights that may enhance future clinical practice and preventive strategies.

We report a rare fetal presentation of tetralogy of Fallot and complete atrioventricular block linked to maternal anti-Ro antibodies. However, trisomy 21 was confirmed postnatally. Despite pacemaker implantation, the neonate died on day 55 due to pulmonary complications. This complex case highlights diagnostic and management challenges involving tetralogy of Fallot, Down syndrome, and complete heart block associated with maternal autoantibodies.