We describe a three-year-old girl in whom arthritis developed ten days after the onset of illness, followed by clinical features consistent with rheumatic carditis and pneumonia. Treatment with prednisone proved satisfactory. This case illustrates the persistence of patterns of rheumatic fever in northeast Brazil which are most unusual in developed countries

A fistula from the pulmonary artery to the left atrium is a very rare congenital anomaly. The communication, almost exclusively arising from the right pulmonary artery, may give rise to a variety of symptoms with cyanosis as the predominant sign. To our knowledge only seven neonates have been reported with this anomaly, and five of them died postoperatively. We present another two neonates with such a fistula which was closed by simple ligation using a transsternal approach and cardiopulmonary bypass. Both patients had an uneventful postoperative course and are alive and well at the age of two and three years, respectively.

We report a patient with tetralogy of Fallot and pulmonary atresia in whom the predominant extracardiac supply of arterial blood was via an aortopulmonary window. Major aortopulmonary collateral arteries originating from the descending thoracic aorta provided an additional source of pulmonary blood flow. The patient underwent successful correction and the postoperative recovery was uneventful.

while preferential blood flow to the right pulmonary artery has been described in transposition of the great arteries with or without obstruction of the left ventricular outflow tract, this disparity of pulmonary blood flow is not present in newborns.1 We report a newborn with transposition in whom there was discontinuity of the pulmonary arteries and ductal blood supply to the left pulmonary artery. To our knowledge, this entity has not been described in newborns with transposition of the great arteries {S,D,D}.

A neonate presenting with persistent pulmonary hypertension and severe hypoxemia was treated with nitric oxide administered into a head-box. Improvement of clinical, biochemical and echocardiographic parameters were observed during therapy, suggesting an acute decrease of pulmonary arterial pressure. It is feasible to administer nitric oxide to non-ventilated neonates provided all recommended safety precautions are observed

the use of prostaglandians in maintaining the patency of the arterial duct in congenital heart disease is well established. Intravenous1-3 and ora12–4 administration has been used, although for acute use intravenous and possibly intraosseous5 routes are favored. Both prostaglandin E1 (alprostadil—ProstinVR: Upjohn)1,4 and prostaglandin E2 (dinoprostone—Prostin E2: Upjohn)2,3 are used for this purpose, although only prostaglandin E1 is licensed for this indication in the United Kingdom. Prostaglandin E1 costs approximately 8 times more than prostaglandin E2 (£56.96 versus £7.43 per vial).

Horseshoe lung is an exceedingly rare congenital malformation, characterized by unilateral pulmonary hypoplasia together with a midline isthmus producing fusion of the tissues of the lower lobes. It is frequently associated with other cardiac and extracardiac anomalies. We report an infant with a variant of the horseshoe lung with partial anomalous venous connection of intracardiac type, ventricular septal defect, and persistent left superior caval vein. There was no pulmonary hypoplasia.

A central polytetrafluorethylene shunt was constructed in a 13-year-old boy after previous placement of a Waterston-Cooley shunt. Because of excessive leakage of serous fluid from the prosthesis, the boy required a second operation when the shunt was wrapped with absorbable collagen hemostat (Novacol FibrillarTM). The leakage stopped suddenly and the boy was discharged home after one week. Follow-up at four months shows no pericardial effusion and good function of the shunt.

Apart from its original use for closing an open duct, the Rashkind ductal occluder has been used to close a variety of other defects. We report successful use of this device to close a residual aortopulmonary window persisting after corrective surgery had been carried out at the age of six months.

We report two patients in whom an initially completely closed arterial duct reopened 6–12 months after implantation of the Rashkind USCI® umbrella. We are not aware of any other reports of this occurrence. No obvious reason could be found for the recanalization.