Spurting coronary artery in the pericardial cavity is observed rarely. Pericardial tamponade occurs and myocardial salvaging time starts ticking. Coronary artery perforations (CAP) have been quoted in literature to range from 0.1 % to 0.7 % of percutaneous coronary artery intervention (PCI) cases. Data was collected retrospectively from the patients of Sri Jayadeva Institute of Cardiovascular Sciences and Research in 2012-2019. A total of 2556 PCI were found in our database of which emergency surgical intervention were needed in 4 patients (0.15 %). Decision making in type 3 CAP with hemodynamic instability is highlighted. Although covered stents and balloons are used to stem the leak, importance of an on call cardiac surgeon cannot be exemplified if the situation is not under control.

Objective: Myxomas are uncommon in the pediatric age group. However, acute cerebral infarcts in children are most often secondary to a myxoma. Early diagnosis is essential in such cases to prevent further such episodes, thereby decreasing the risk of permanent neurological deficits. In the pediatric age group, a high index of suspicion is required to diagnose such rare causes. Most myxomas are benign in nature, and hence surgery can offer complete curative resection and also help avoiding further incidents of cerebrovascular accidents (CVA). Here, we present an interesting case of an 8-year-old female child who presented with acute right-sided hemiplegia and was incidentally detected with a left atrial myxoma. Case presentation: An 8-year-old female presented to the emergency department with the complaint of loss of consciousness for 1 hour. There was no preceding history of trauma and no associated seizures.Computed tomography and magnetic resonance imaging of brain revealed an acute thalamic infarct and 2D echocardiography showed a mass lesion in the left atrium. Mass was excised, and histopathology confirmed it as a benign myxoma. Conclusion: Myxomas are a rare cause of CVA in children, making the diagnosis challenging. A high index of suspicion with a multidisciplinary approach is necessary for early diagnosis and appropriate management of such cases.