Fetal balloon aortic valvuloplasty (fBAV) is performed in carefully selected fetuses with critical aortic stenosis to prevent progression to hypoplastic left heart syndrome. We report a fetus with critical aortic stenosis who underwent successful fBAV at 26 weeks’ gestation with restoration of antegrade aortic flow. Serial fetal echocardiography subsequently demonstrated progressive restriction and eventual functional closure of the foramen ovale despite technically successful valvuloplasty. Pulmonary venous Doppler revealed a prominent atrial reversal wave with prolonged reversal duration, while mitral inflow showed marked E-wave predominance, indicating elevated left atrial pressure and severe left ventricular diastolic dysfunction. After birth, the neonate developed pulmonary hypertension physiology with persistently elevated left ventricular end-diastolic pressure despite postnatal balloon aortic valvotomy. This case highlights that pulmonary venous Doppler provides a valuable noninvasive marker of restrictive atrial physiology and may identify fetuses at risk of adverse neonatal hemodynamics despite successful relief of aortic valve obstruction.

We report a rare case of a 2-year-old child presenting 48 h after accidental penetrating chest trauma due to a fall from a motorcycle, with a retained foreign body lodged within the pericardial sac. Imaging revealed an opaque object overlying the cardiac silhouette. On median sternotomy, approximately 50 mL of pericardial blood was evacuated, and a piece of metallic debris was found resting beneath the left atrial appendage without injury to cardiac structures. The foreign body was successfully removed without cardiopulmonary bypass, and the child had an uneventful recovery. Retained foreign bodies in the pericardium following blunt–penetrating trauma in pediatrics are exceedingly rare and require a high index of suspicion and appropriate imaging. Surgical exploration remains the definitive treatment when pericardial injury or cardiac tamponade is suspected.

Noonan syndrome (NS) is a multisystem disorder with frequent heart defects, including hypertrophic cardiomyopathy (HCM). Left ventricular (LV) apical aneurysm is an extremely rare presentation in pediatric HCM. A 4-year-old child with NS, PTPN-11 mutation and HCM presented with progressive mid-cavity LV obstruction leading to a large LV apical aneurysm. Magnetic resonance imaging confirmed a large, wide-neck LV apical aneurysm. Surgery combined septal myectomy and patch repair of the aneurysm, resulting in uneventful recovery and significant gradient reduction. While multimodal imaging assists surgical planning, longitudinal surveillance should look for recurrences of aneurysm from the repaired segment, arrhythmia, and myocardial function.

Fetal bradycardia is primarily a symptom of fetal distress or intrauterine injury. This can result in fetal cardiac insufficiency, fetal edema, or even fetal death. This condition once perplexed doctors and often resulted in the induction of labor, breaking the hearts of many families. Here, we present two cases of fetal bradycardia with favorable outcomes, offering hope for the survival of affected babies.

Congenital coronary artery fistula (CAF) is a rare anomaly, accounting for approximately 0.4% of congenital heart defects. It is characterized by an abnormal connection between a coronary artery and one of the cardiac chambers or great vessels. Depending on the degree of shunting and coronary steal, it can lead to severe congestive heart failure, even in the neonatal or early infantile period, sometimes requiring early intervention. We report a neonatal case of heart failure caused by a giant right CAF that was successfully treated with transcatheter closure using an Amplatzer™ Vascular Plug II. Transcatheter closure of CAF in the neonatal period may serve as a minimally invasive and safe therapeutic option.