Incorporation of HFPS into a preexisting pediatric cardiology rotation was feasible and well received. Our study suggests that simulation promotes increased confidence and may modestly improve clinical reasoning compared to traditional educational techniques. Targeted simulation sessions may readily be incorporated into pediatric subspecialty rotations.

In high-risk patients, the hybrid procedure appears to have lower 30-day mortality and may have a survival benefit in premature patients and those less than 2.6 kg. Long-term attrition in this high-risk population is ongoing regardless of early strategy.

Transcatheter valve replacement is now widely used to treat high-risk patients. This approach is also expanding to the tricuspid valve, mostly for "valve-invalve" and "valve-in-ring" implantations. Rapid pacing during transcatheter valve implantation is used to reduce cardiac output and minimize the risk of valve dislodgement. Rapid pacing is usually done using the patient's permanent pacemaker or a temporary pacing electrode that is usually introduced retrogradely into the left ventricle or coronary sinus. Here, we describe the use of the tricuspid valve-in-valve implantation super-stiff guidewire for rapid pacing during implantation of the valve. This approach may obviate the need for ancillary steps that may increase procedure time, X-ray exposure, and risk of complications.

Mitral valve replacement, which is a relatively rare procedure in young children, can be complicated by paravalvular leaks (PVLs). Here, we report the first successful percutaneous treatment of a PVL in an infant.