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The Occlutech Atrial Flow Regulator (AFR) is a self-expandable double-disc nitinol device with a central fenestration. Its use has been approved in the adult population with heart failure and described for pulmonary hypertension (PH). Only case reports and small series have been published about its use in the paediatric population and for congenital heart disease (CHD). The authors sought to investigate the feasibility, safety, and short-term follow-up of AFR implantation in patients with CHD or children with PH or cardiomyopathy. This is a multicenter retrospective study involving 10 centers worldwide. Patients of any age with CHD or patients aged < 18 years with PH or cardiomyopathy needing AFR implantation were included. A total of 40 patients underwent AFR implantation. The median age of the population at the time of the procedure was 58.5 months (IQR: 31.5-142.5) and the median weight was 17 kg (IQR: 10-46). A total of 26 (65.0%) patients had CHD, nine (22.5%) children, a cardiomyopathy, and five (12.5%), a structurally normal heart. The implantation success rate was 100%. There were two early and one late device thrombosis. Two patients (5.0%) with dilated cardiomyopathy on extracorporeal membrane oxygenator (ECMO) died during the hospital stay. At a median follow-up of 330 days (IQR: 125-593), 37 (92.5%) patients were alive. At follow-up, 20 patients improved their New York Heart Association (NYHA) class, 12 patients did not change their NYHA class, and one patient with idiopathic PH worsened. AFR implantation in patients with CHD and children with severe PH or cardiomyopathy is promising and seems to have beneficial effects at short-term follow-up.

We describe a 12-year-old boy with agenesis of the intrahepatic segment of the inferior vena cava (a rare congenital anomaly) in whom an electrified coronary guidewire with electrocautery was used percutaneously to perforate and open the atretic segment, followed by stent implantation. This technique may be a safe and feasible option for paediatric patients, offering a therapeutic alternative for complex cardiac anatomies.

Coronary artery fistulas have been described in patients after heart transplantation more often than in the normal population. We reviewed our centre’s database between 2008 and 2020. Thirty patients had coronary angiography and 13 showed non-cameral coronary artery fistulas in their first coronary angiography. Distribution, degree and evolution of the fistulas and characteristics of transplant procedure, patient and immunosuppressive treatments were analysed.

Percutaneous closure of atrial septal defect is recognised as a safe and effective procedure, however, in some patients complications may occur. Although chest pain has been sporadically reported, its exact aetiology has been poorly studied. Herein, a 14-year-old female with an atypical and long-lasting chest pain after percutaneous atrial septal defect closure is described.

A 4-year-old child of 10 kg weight, with four previous sternotomies, presented a severe right heart failure, due to a severe regurgitation of his bioprosthetic tricuspid valve. A percutaneous tricuspid valve in valve procedure with an Edwards S3 valve was offered for compassionate use, and performed, with no complications, and significant clinical condition improvement.

We implanted two sinus Superflex DS © stents in a systemic non-stenotic arterial duct of a newborn with hypoplastic left heart syndrome. Forty-eight hours later an important collapse of the stent was detected and treated with a balloon expandable stent. Sinus Superflex DS © has been specifically designed for systemic ducts. This complication generates doubts about its radial force in this scenario.

We report an asymptomatic 5-year-old boy with coronary artery fistulas to pulmonary parenchyma and to systemic thoracic arteries, like a “natural bypass”, detected during a coronary angiography performed 11 months after his heart transplant. One year later, a new coronary angiography showed no fistula. Some changes to immunosuppressive therapy during this time could be related to this evolution.

Abstract Background The Edwards Sapien percutaneous valve (Edwards Lifesciences, Irvine, CA, USA) is a promising therapeutic option for congenital atrioventricular disease mostly because of the possibility to accommodate somatic growth with balloon dilatation. Case summary This article reports the performance of the Edwards Sapien 3 valve in atrioventricular valve position in four paediatric patients. Discussion Despite aggressive antiplatelet and anticoagulation strategies, most patients showed early bioprosthesis dysfunction, with increasing gradient not related with somatic growth. The decrease in leaflet motility in the absence of thrombosis or pannus could be associated with the low-velocity flow and low-pressure gradient that exists between the atria and ventricles in small children. It is well-known graft lifespan is usually shorter in small children, but we hypothesize the possibility of a second factor that valve design is intended to support higher flow-velocity patterns and can present an early failure in low-flow low-pressure situation. More studies are necessary to provide reliable evidence.

We describe the progress of a girl aged 5 years, who suffered blunt trauma to the chest producing a ventricular septal defect of 1 centimetre in diameter. The shunt generated a mild dilation of the left-sided chambers, and exertional dyspnoea. Three months later, therapeutic catheterisation revealed important diminution in the extent of shunting. We decided, therefore, not to close the defect, and she has since remained asymptomatic.