Clinical experience during fellowship training and post-graduation depends on training length, resources, and time at specific institutions, contributing to knowledge deficits. Institutional collaboration overcomes such barriers wherein case discussions share knowledge and management strategy, enhancing patient outcomes. Our discussion of the management of Tetralogy of Fallot highlights key insights between programmes differing in geography and resources, hosted by Heart University.

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.

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.

A one-year-old boy with repaired tetralogy of Fallot presented with recurrent fever. Blood cultures grew Streptococcus mitis/oralis, but transthoracic echocardiography showed no infective endocarditis. Cardiac CT angiography revealed an occult right ventricular outflow tract pseudoaneurysm, which was surgically resected. This case highlights CT angiography as a critical diagnostic tool when echocardiography fails to identify infectious sources in CHD.