Spontaneous rupture of a coronary artery fistula presenting with post-exertional syncope and haemopericardium.

An 8-year-old with a known diagnosis of an asymptomatic coronary artery fistula (CAF) presented with exertional syncope and haemopericardium due to contained rupture of CAF. A transcatheter closure was attempted, but the fistula ruptured again prompting emergency surgical repair. Spontaneous rupture is a catastrophic complication of CAF and warrants a high index of suspicion, timely diagnosis and team management.

Symptomatic Tetralogy of Fallot in Young Infants: Primary Repair or Shunt-Pediatric Health Information System Database Analysis.

BACKGROUND: Compare the early outcomes and hospital charges of early primary repair and systemic-to-pulmonary artery shunt for neonates and young infants (≤90 days of age) with tetralogy of Fallot using data from the Pediatric Health Information System database. METHODS: The Pediatric Health Information System database was queried for patients <90 days of age with primary diagnosis of tetralogy of Fallot who underwent nonelective surgical repair or palliation between January 2008 and December 2014. The initial cohort of 821 patients (group 1 early primary repair, N = 554; group 2 systemic-to-pulmonary artery shunt, N = 267) was propensity score matched (248 patients in each group) to account for baseline imbalances in age and prostaglandin use. RESULTS: Comparison of unmatched groups revealed younger age and higher incidence of extracardiac anomalies ( P = .02) and prematurity ( P = .04) in group 2. Mortality was comparable between the groups (group 1: 20 [4%] of 554 vs group 2: 11 [4%] of 267, P = .74). Irrespective of the type of procedure, prematurity (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.5-7.4) and extracardiac anomalies (OR = 2.5, 95% CI: 1.2-5.3) were independent risk factors for mortality. Propensity score-matched analysis revealed no significant differences in patient mortality ( P = 1), duration of ventilation ( P = .64), hospital length of stay ( P = .69), or hospital charges ( P = .08) between the two groups. CONCLUSION: Outcomes and hospital charges associated with nonelective early primary repair are comparable to systemic-to-pulmonary artery shunt in symptomatic patients <90 days old with tetralogy of Fallot.

Transatrial Endocardial Placement of Epicardial Pacing Lead.

We report a technique wherein an epicardial pacing lead was placed transatrially to achieve optimal pacing in a patient with a complex venous anatomy.

Acute endocarditis of a percutaneously placed pulmonary valve.

Endocarditis of percutaneously placed pulmonary valve is increasingly being recognized and reported as a potentially life-threatening complication. In this report, we discuss a 17-year-old male who presented with septic shock secondary to staphylococcal endocarditis of a percutaneously placed pulmonary valve.