Using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database, we evaluated paediatric cardiovascular mortality across the United States from 2003 to 2023. The overall paediatric cardiovascular mortality declined from 4.73 to 3.17 per 100,000. There were reductions in mortality among large metropolitan, medium/small metropolitan, and nonmetropolitan counties with no rural–urban disparities. In addition, there were declines in mortality by age, sex, and racial/ethnic groups, highlighting geographic equity in paediatric cardiovascular outcomes.

Pulmonary artery sling is a rare congenital anomaly in which the left pulmonary artery arises anomalously from the right pulmonary artery. With rigorous pre-operative assessment, we successfully repaired isolated pulmonary artery sling using left thoracotomy in a highly selected group of children. In this modern series, we have achieved satisfactory surgical outcomes without using cardiopulmonary bypass support.

An infant with junctional ectopic tachycardia developed tachycardia-induced cardiomyopathy requiring extracorporeal membrane oxygenation for circulatory failure. After oxygenation withdrawal became feasible following intravenous antiarrhythmics, tachycardia recurred with oral transition. Subsequent ivabradine administration resulted in heart rate control and improved cardiac function. We emphasise the role of ivabradine in heart rate control and cardiac function stabilisation in junctional ectopic tachycardia.

Despite being rare within paediatric patients, emerging evidence shows that low QRS voltage may be a risk factor for increased mortality even in formerly healthy patients. The prognostic value of low-voltage electrocardiography in a paediatric population has yet to be defined. Here, we present a case of an adolescent experiencing sudden cardiac arrest after Parvo B19-associated myocarditis. A striking finding was a marked low-voltage electrocardiography throughout the following years.

Transcatheter closure is the preferred treatment for type 2 atrial septal defects. Device retrieval for embolisation or malpositioning is rarely necessary and can often be performed percutaneously. However, transcatheter retrieval of Occlutech Figulla Flex II atrial septal defects occluders >16 mm can be very difficult, and it has even been stated to be impossible in the literature. Its right atrial hub is ball shaped so that snare devices could slip off when retrieving a large device into a sheath, necessitating the use of multiple snare or other retrieval devices. We present three paediatric cases (four procedures in total) of successful > 16 mm Occlutech atrial septal defect occluder retrieval using a single Multi-Snare® device.

Middle aortic syndrome is a rare cause of aortic coarctation, characterised by progressive segmental or diffuse narrowing of the distal thoracic aorta and/or abdominal aorta, often involving the renal arteries and other visceral arteries. The syndrome is predominantly seen in children and young adults, typically presenting with severe hypertension, congestive heart failure, renal failure, or severe leg claudication. Diagnostic imaging by angiography of the descending and abdominal aorta is the preferred evaluative modality. Here, we report a case of a young man who was admitted to our Cardiology Department with severe hypertension and middle aortic syndrome diagnosed by renal Doppler scan and CT angiography. An adequate blood pressure control was achieved with antihypertensive treatment and surgery.

To illustrate the effectiveness of radiofrequency catheter ablation as a therapy for paediatric patients with frequent premature ventricular contractions that are refractory to medical treatment and associated with reduced cardiac function. In patients with multifocal ectopic premature contractions of localised regional origins, radiofrequency catheter ablation may be more beneficial than pharmacologic therapy.

Neonatal ectopic atrial tachycardia is a rare arrhythmia that may be resistant to conventional therapy. We report a neonate with persistent foetal tachycardia refractory to flecainide and digoxin. Ivabradine resulted in rapid and sustained heart rate reduction without haemodynamic compromise. This case supports ivabradine as a therapeutic option in neonatal automatic tachycardias when standard treatments fail.

Device embolisation is one of the most feared early complications of percutaneous atrial septal defect closure. We report a 40-year-old woman in whom a 12-mm atrial septal defect occluder was accidentally displaced into the descending aorta 24 hours after an apparently successful procedure. The dislodged device was retrieved percutaneously through a 12-F long sheath that was continuously railroaded over a super-stiff guide wire. This “retained super-stiff guide wire” technique secured sheath stability, avoided aortic wall trauma, and allowed the occluder to be slipped into the sheath without change of its orientation. A larger 16-mm small-waist–big-edge device was subsequently implanted uneventfully. The technical details and advantages of keeping the sheath constantly over a super-stiff guide wire are highlighted to facilitate safe trans-arterial retrieval of embolised cardiac devices.

Spontaneous rupture of a giant coronary artery aneurysm is a rare and almost uniformly fatal complication of Kawasaki disease. We report an 18-month-old boy with incomplete, immunoglobulin-resistant disease whose giant aneurysms ruptured despite pulse corticosteroids, anakinra, bedside sternotomy, and extracorporeal support. Six comparable paediatric cases are reviewed, underscoring that aggressive therapy may not prevent rupture once structural arterial wall destruction has occurred.

Ankyrin-B syndrome, which has been linked to variants in ANK2 and classified as long QT syndrome type 4, is characterised by heterogeneous arrhythmic manifestations, including sinus node dysfunction and conduction abnormalities. Clinically significant atrioventricular block requiring permanent pacing in paediatric patients has rarely been described. We report a 10-year-old boy who presented with recurrent syncope and seizure-like episodes. Electrocardiography demonstrated QT prolongation, and continuous monitoring revealed persistent high-degree atrioventricular block. Genetic testing identified a heterozygous ANK2 variant of uncertain significance (NM_001148.4:c.5626G>A, p. Glu1876Lys), which was also detected in his mother and brother, while his father tested negative. Family evaluation revealed variable phenotypic expression, and a sister who died suddenly at 12 years of age had no available genotype but had autopsy findings of structural cardiac abnormalities. This case highlights clinically significant conduction disease in a child found to harbor an ANK2 VUS and long-QT phenotype and underscores the importance of detailed family phenotyping, rhythm surveillance, and individualised management.

In cases of isolated left brachiocephalic artery, if both ductus arteriosus remain patent, excessive pulmonary blood flow can occur, and cerebral perfusion may be compromised by a steal phenomenon, potentially leading to cerebral atrophy. We report a case of an isolated left brachiocephalic artery with bilateral patent ductus arteriosus in which transcatheter closure of both ductus arteriosus was successfully performed.

As the Association for European Paediatric and Congenital Cardiology, the largest paediatric cardiology organisation globally, we are dedicated to safeguard the health, safety, and wellbeing of children, adolescents, and adults with congenital and acquired heart disease, as well as to support the professionals who care for them across the globe. As both a scientific and ethical community, we are profoundly troubled by the devastating humanitarian consequences of armed conflicts. Across the world, we are witnessing an immense toll on civilians, particularly children, who are always the most vulnerable in times of war. The destruction of healthcare infrastructure, obstruction of access to medical care, and the severe psychological and physical trauma endured by children are deeply alarming. While the Association for European Paediatric and Congenital Cardiology does not engage in political debate, we cannot remain silent when children’s lives and futures are endangered. We stand firmly by our values of compassion, equity, and peace and voice our deep concern for all (children) affected by violence and conflict, irrespective of their country, ethnicity, nationality, or faith. We invite our members and partner societies to join in upholding the principle that every child, everywhere, deserves to grow up in peace, with access to healthcare, and to live free from violence.