KD patients with reduced mean haemoglobin, increased AST level, increased neutrophil-to-lymphocyte ratio and reduced platelet count should be considered for conjunctive therapy such as a corticosteroid in combination with standard treatment. Duration of fever ≥8 days and platelet count ≥550 × 10/L were predictors of CAA. To prevent cardiovascular complications, patients should be treated promptly after KD has been diagnosed.

Our findings identify Slit-Robo as a significant pathway in human heart development and CHD.

Objectives To assess feasibility and early outcomes of using BeGraft Aortic stent in the treatment of aortic coarctation (CoA). Background BeGraft Aortic stent (Bentley InnoMed, Hechingen, Germany) allows large postdilation diameter up to 30 mm. With availability of lengths of 19–59 mm and lower stent profile, they can be used in native and recurrent CoA in adults and in pediatric patients. Materials and methods This is a multicentre retrospective analysis of 12 implanted BeGraft Aortic stents in CoA between May 2017 and April 2019. Results Twelve patients aged 7.7–38 years (median 18.3 years) with body weight of 19.9–56 kg (median 45.5 kg). Eight patients (66%) had native juxtaductal CoA while four had recurrent CoA after previous surgical or transcatheter treatments. The stents were implanted successfully in all the patients with no serious adverse events. The length of the stents ranged from 27 to 59 mm and the implanted stent diameter varied from 12 to 18 mm. The median intraprocedural CoA pressure gradient decreased from 25 mmHg (range 16–66 mmHg) to 2 mmHg (range 0–13 mmHg). The mean follow‐up duration was 10.2 months. Two patient (16.6%) had residual stent narrowing requiring staged redilation. One patient (8%) had pseudoaneurysm formation at 1 year cardiac CT follow‐up. Conclusions The BeGraft Aortic stent may be considered to be safe and effective in the short term in treatment of CoA from childhood to adulthood. Long‐term follow‐up is needed.

SUMMARYThe incidence of diphtheria has decreased since the introduction of an effective vaccine. However, in countries with low vaccination rates it has now become a reemerging disease. Complications from diphtheria commonly include upper airway obstruction and cardiac complications. We present a 9-year-old boy who was diagnosed with diphtheria. He presented with fever, tonsilar plaques, respiratory failure and an incomplete vaccination history. He was endotracheal intubated and received diphtheria antitoxin and penicillin on the first day of hospitalisation. He developed progressive arrhythmias and fulminant myocarditis despite early identification and treatment with equine antitoxin and antibiotics. After a temporary transvenous pacemaker insertion due to thirddegree atrioventricular block and hypotension for 1 week, he developed myocardial perforation from the pacemaker tip resulting in pericardial effusion. The treatment included emergency pericardiocentesis and pacemaker removal. His electrocardiogram showed a junctional rhythm with occasional premature ventricular complexes. He then developed ventricular tachycardia and cardiac arrest and finally died. BACKGROUND

Insertion of a ventriculoperitoneal shunt is a common neurosurgical procedure in both adult and paediatric patients. It is one of the most important treatments in cases of hydrocephalus; however, there is a wide range of complications: the most common complication being a shunt infection, and examples of rare complications are shunt migrations and cardiac tamponade. Several reports of distal ventriculoperitoneal shunt migration in different sites, including chest, right ventricle, pulmonary artery, bowel and scrotum were published. But pericardial effusion with cardiac tamponade and its relationship to distal ventriculoperitoneal shunt migration into the pericardial sac has never been reported.

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

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Iatrogenic arteriovenous fistula is not a common complication of central venous catheterization. Duct occluder devices have been developed for patent ductus arteriosus occlusions but they may be used for arteriovenous fistula closures. We report a case of iatrogenic brachiocephalic-jugular and aortopulmonary artery fistulas after central venous catheter insertion. The fistulas were successfully managed with duct occluder devices. Due to increasing number of central venous catheterizations, physicians should be aware of this uncommon complication. Transcatheter closing of brachiocephalic-jugular and aortopulmonary artery fistulas by duct occluder devices seems to be a safe and feasible form of treatment.