It is not uncommon to have prolapse of the atrial septal occluder device despite accurate measurement of atrial septal defect and an appropriately chosen device. This is particularly a problem in cases with large atrial septal defect with absent aortic rim. Various techniques have been described for successful implantation of atrial septal occluder in such a scenario. The essence of all these techniques is to prevent prolapse of the left atrial disc through the defect while the right atrial disc is being deployed. In this brief report, we illustrate the use of cobra head deformity of the device to successfully deploy the device across the atrial septum.

itamin D has harnessed vast attention in medical research as well as clinical practice for the past few decades [1][2][3]. Role of Vitamin D has indeed expanded from bone health to a myriad of physiological as well as pathological conditions in humans. Classic childhood signature statement of Vitamin D deficiency (VDD) is a disorder called rickets which disproportionately targets growing bones [4][5][6][7]. Vitamin D deficiency with a resurgence of rickets is increasingly being reported in infants and toddlers from various parts of the world, especially from temperate regions and among African-American and Indian children [2][3][4][5]. A series of studies from different parts of our country have also pointed towards widespread VDD in Asian Indians of all age groups including neonates, toddlers, schoolchildren, pregnant women, and adults [8][9][10][11]. Most studies published from India showing wide ranging VDD (75-90%) had mainly focused on pregnant women, newborn babies, schoolchildren, and adolescents [12][13][14].Although Indian Academy of Pediatrics "Guideline for Vitamin D and Calcium in Children" Committee has recommended daily Vitamin D supplementation of 400 IU for infants beyond neonatal period [15], studies evaluating Vitamin D levels of infants before the initiation of complementary feeding are limited [16]. In a study by Seth et al., Vitamin D levels of exclusively breastfed infants and their mothers (n=180) were studied, but the age of the group of 4-6 months infants was less than one-fourth of the total study cohort and they did not study infants on breast milk substitutes [16]. In this backdrop, our study aimed to estimate prevalence of Vitamin D deficiency in healthy infants at 4-6 months of age (a period immediately before initiation of complementary feeding) attending tertiary care center for routine OPD consultations. In addition, we explored the demographic, anthropometric, and feeding related factors associated with Vitamin D deficiency in these young infants. MATERIALS AND METHODSWe carried out a cross-sectional survey in pediatric outpatient department of a tertiary care North Indian hospital between April

Heart failure secondary to isolated pulmonary artery vasculitis is rarely described in children. We describe a 10-year-old child who presented with right heart failure symptoms, severe pulmonary hypertension, and bilateral branch pulmonary artery stenosis secondary to isolated pulmonary artery vasculitis. ( Level of Difficulty: Advanced. )

A 35-year-old female presented to us with a history of exertional dyspnea from the last 20 years and low oxygen saturation noticed from last 1 month during her COVID-19-related illness. The patient did not seek medical attention over these years as the degree of limitation of physical activity was modest. She had a bad obstetric history: five second trimester pregnancy losses and one early neonatal death. Her symptoms were worse during pregnancy and improved thereafter. Physical examination was notable of cyanosis and features of pulmonary hypertension (PH). Echocardiography was suggestive of double outlet right ventricle, large subaortic ventricular septal defect with bidirectional shunt, and severe PH. This case highlights a variable clinical outcome of Eisenmenger syndrome in pregnancy. We did a literature review for studies reporting the outcomes of PH in pregnancy. The overall mortality rates seem to have declined dramatically from as high as 56% reported in studies in the 1990s to < 5% in more contemporary studies. The common adverse obstetric outcomes include prematurity and growth restriction.