Device closure of secundum atrial septal defects using Amplatzer Septal Occluder is safe and effective in the medium term. Short inferior caval vein margin correlates with increased risk of embolisation and short superior caval vein margin with a residual shunt. The risk of developing aortic regurgitation is low and correlates with increased device-to-defect ratio.

Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.

Objectives:The study was conducted to check the frequency of development of complication in the patients with small Ventricular Septal Defects (VSDs) considered not requiring surgical closure during childhood. Methods: A descriptive study was conducted on children from January 2015 to December 2015 at Children Hospital and Institute of Child Health, Lahore, Pakistan. The data with isolated VSDs considered too small to require surgery from 1 month to 15 years of age were reviewed. The data was analyzed with SPSS 20 version. Results: The total of 883 patients of restrictive VSDs considered not to require surgery, 60.6% (n=535) were males and 39.4% (n=348) were females. The significant number of patients i.e. 18.7% (n=166) developed complications. Aortic cusp prolapsed developed in 13.6% i.e. p≤0.05, 2.3% developed aortic regurgitation secondary to aortic cusp prolapsed. 1.8% developed right ventricular track outflow obstruction (RVOT) i.e. p≤0.05 and 0.3% of patient developed left ventricular outflow track obstruction (LVOT) i.e. p≤0.05. Similarly 0.8% patients developed endocarditis. Regarding types of VSD, we found Perimembranous in 65.8%, muscular in 12.6%, Subaorticin 8.3%, doubly committed in 6.0%, Inlet in 5% and outlet in 1.7% of our patients. Conclusions: Patients with small restrictive Ventricular Septal Defects (VSDs) generally been considered as do not required surgery, the data suggested that a significant percentage of these patients developed complications later in their life i.e., 18.7%.

Background: Coarctation of the aorta (CoA) is one amongst commonest congenital heart diseases (CHD) which reuires early intervention to avoid morbidity and mortality. Balloon angioplasty (BA) can be offered in place of surgery in selected cases. Aim: To evaluate the safety of procedure and efficacy of catheter intervention balloon angioplasty for CoA as an alternative to surgery and to identify the factors related with poor outcome of the intervention in infants and children Methods: The study was a retrospective observational cohort study of 46 infants and children undergoing BAS during a six-year period (Jan 2014 to May 2020). Demographic detail history and investigation including echo and ECG were collected for all the patients. Immediate pre and post procedure complications were noted. Results: Forty six (46) children and infant patients , underwent balloon angioplasty 29 were male and 17 were female. Patients were divided into two groups. Group A included patient with successful outcome and group B included those with suboptimal results. Characteristics of both groups we studied. In group A the median age was 6.3 years and median weight was 15 kg whereas in group B median age was 3.5 years and median weight was 9 kg. Forty patients had native CoA (86.9%) while six patients were post op (13%). There was no mortality. One patient had a small aneurysmal formation (3%). Four patients had a transitive loss of pulse. Thirty-four patients had a successful outcome (73.9%) while twelve patients had a suboptimal result (26%). Conclusion: Coarctation angioplasty has good early outcome and it can be considered as a sustainable alternative to surgery in critical infants and children patients high risk of mortality with surgery. wise selection of patients, use of improved low-profile catheters and better patient care can reduce the complications and incidence of mortality. Keywords: Coarctation, Balloon angioplasty

Objective: To determine the frequency of various anatomical cardiac anomalies and variations in children with Tetralogy of Fallot diagnosed by cardiac catheterization. Study Design: Cross sectional study. Place and Duration of Study: Children's Hospital and Institute of Child Health Lahore, from Jan 2010 to Dec 2018. Methodology: All children with tetralogy of fallot underwent standard cine-angiograms after obtaining written consent following basic laboratory workup. Results: Out of 425 patients, 398 completed cardiac catheterization. The median age was 6 years (interquartile range 3.5-9 years). Confluent Branch pulmonary arteries were present in 395 (99%) children. Pulmonary artery abnormalities were detected in 72 (18%) patients. Two hundred and eleven (53%) children had 283 major aortopulmonary collateral arteries with 88 having 2 or more major aortopulmonary collateral arteries. Out of all, 195 (92%) had hemodynamically significant Major aortopulmonary collateral arteries (supplying ≥3 lung segments) with 54 (28%) having small (<1.33mm at origin), 105 (54%) moderate (1.33-1.67 mm at origin) and 36 (18%) large (>1.67 mm at origin) caliber. Conclusion: The frequencies of pulmonary artery abnormalities and various anatomic variations missed on echocardiography in the studied population were high. Diagnostic cardiac catheterization is still a relevant invasive diagnostic procedure in children with tetralogy of fallot. Keywords: , , , , , , .