Truncus arteriosus (TA) is a congenital cyanotic heart disease with admixture physiology at the great arterial level. It can have associated anomalies of the pulmonary arteries, truncal valve narrowing, etc., Total pulmonary venous anomalous drainage associated with TA is extremely rare. We report a sick young infant who presented with type I TA and obstructed infracardiac total anomalous pulmonary venous return.

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Valvular pulmonary stenosis (PS) can present with cyanosis and right heart failure in older children and adults. Transcatheter balloon pulmonary valvuloplasty is a standard intervention for severe valvular PS in all age groups. Balloon dilatation in critical PS like presentation in older age groups has unique challenges in management. These cases are associated with right ventricular dysfunction, cyanosis, pulmonary edema, injury to right ventricular structure, and arrhythmia. Imaging is an essential component for diagnosis and management. We present two such cases of older children who presented with cyanosis and right ventricular dysfunction. Detailed imaging and team approach of care helped in managing the challenges of balloon pulmonary valvuloplasty in older sick substrates.

Atrial septal defect (ASD) is one of the common congenital heart anomalies presenting in the geriatric group. It presents with symptoms such as progressive effort intolerance, arrhythmias, and palpitations. Sometimes, associated obstructive and restrictive respiratory diseases can contribute significantly to the symptoms masked by cardiac disease. A female in her seventh decade, presenting with dyspnea, had a large ASD with diastolic dysfunction and moderate pulmonary hypertension. She had persistence of symptoms after initial treatment for cardiac elements. On detailed evaluation, she was found to have mixed obstructive and restrictive respiratory disease. She was treated for respiratory elements under expert pulmonology guidance with significant improvement. The ASD was occluded with a custom-made fenestrated 40 mm LifeTech atrial septal occluder in view of diastolic dysfunction and initial pulmonary arterial hypertension. She remained symptomatically better on her short-term follow-up. The index case highlights the importance of detailed evaluation of elderly patients with large ASDs and individualized care to treat.