Extra-corporeal membrane oxygenation (ECMO) implantation is limited to specialized centres with cardiac surgery facilities. ECMO implantations in centres without on-site cardiovascular surgery facilities have been reported with ECMO system and surgeon dispatched from the referring hospital. We report the circumstances, feasibility, in-hospital complications and outcomes of ECMO implantation by an interventional cardiology team in a local hospital with a high-volume catheterization laboratory but without on-site cardiovascular surgery facilities Study hospital The Hospital Centre of Annecy hosts a catheterization laboratory available 24 hours a day, 7 days a week (24/7), with a team of 12 interventional cardiology nurses and four interventional cardiologists. The hospital catchment area covers a population of 900 000 people. One thousand to1200 percutaneous coronary interventions (PCIs) are performed annually. This local hospital does not have a cardiac surgery department. The nearest cardiac surgical hospital is located 100 km away.

Ventricular late potentials, and dispersion of the QT interval, are markers for risk of ventricular arrhythmias. Normal values for these parameters are well established in adults, but may not apply for children. This study has investigated the age dependency of signal averaged electrocardiographic parameters and QT dispersion in 111 normal children aged from 5 days to 16 years. The results indicate that parameters change with age: duration of filtered QRS and low amplitude (< 40 /zV) terminal signal increase with age, especially in the younger patients. Filtered QRS is 88.9 ± 7.87 ms in infants, and increases to 108.7 ± 8.51 in teenagers (/><0.001). Low amplitude terminal signals are 17.0 ± 3.44 ms in infants, and 24.5 ± 5.64 ms in teenagers (p< 0.001). Root mean square of the last 40 ms decreases with age, but remains stable after the age of 10 years (122.4 ± 33-30 jiiV in infants, 60.9 ± 31.27 in teenagers,p<0.001). QT dispersion, on the other hand, does not change significantly with age. The mean value for the whole group is 36 ± 13.7 ms. A weak but significant correlation exists between QT dispersion and filtered QRS. Thus, age must be taken into consideration when interpreting signal-averaged electrocardiograms, but not when measuring QT dispersion.

Aorto-left ventricular tunnel (ALVT) is a rare congenital heart defect. Surgery has to be performed early to avoid life-threatening complications. Prenatal diagnosis of this defect is challenging. We report a case of ALVT diagnosed in a fetus showing premature severe cardiac failure at 24 GA. The new born was operated at day 3 of life with good results. Two years later, he is still doing well recovering a complete normal cardiac function. ALVT should be suggested in front of any fetal cardiac failure. Thanks to early diagnosis, prompt neonatal management can be organized and allows positive outcome.

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