Late dysfunction of the systemic right ventricle in patients with complete transposition of the great arteries after Mustard or Senning procedures and progressive deterioration of the clinical status has been demonstrated. However, evidence-based data on the effective therapy for systemic right ventricular dysfunction in these patients are yet to be defined. Our patient shows an improvement in the right ventricular systolic function, with a reduction in tricuspid regurgitation and a consequent better exercise tolerance after a hybrid approach consisting of an upgrading of a previous transvenous-implanted dual-chamber Implantable Cardiac Defibrillator to biventricular pacing associated with pulmonary artery banding via an anterior thoracotomy.

Tolvaptan, an oral vasopressin receptor antagonist, was administered to a 6-year-old boy with advanced congestive cardiac failure due to restrictive cardiomyopathy. Slow up-titration of the tolvaptan improved the loop diuretic-resistant congestive cardiac failure without hypernatraemia, deterioration of vital signs, and significant complications. Tolvaptan could be useful and safe for children with severe congestive cardiac failure. It is necessary to accumulate clinical data on tolvaptan administration in children in order to determine the optimal method of administration.

Congenital unruptured aneurysms affecting both the right and left sinuses of Valsalva are extremely rare. To the best of our knowledge, there has been only one previously documented case. We report here a patient presenting with congestive cardiac failure who also had unruptured aneurysms of both the right and left sinuses of Valsalva. The aneurysms produced obstruction of the outflow tracts of both ventricles, burrowing as they did into the muscular ventricular septum.