Prolonged pleural effusion is a fairly common condition which has considerable impact on complicated and longer hospital stays after Fontan surgery. Identifying the patient population prone to have pleural effusions is still seeking for an answer. This study is to determine the variables that may predict prolonged pleural effusion according to the data of 69 patients who underwent Fontan operation between June 2018 and December 2020 and survived to date. Prolonged pleural effusion was defined as the need for a chest tube for more than 7 days. Two patient groups, with and without prolonged effusion, were compared in terms of pre-, peri-, and post-operative variables. The patients were subdivided into "high-risk" and "low-risk" groups based on the pre-operative catheterisation data. The most frequent main diagnosis was tricuspid atresia (n: 13, 19%). Among 69 patients, 28 (40%) had prolonged pleural effusion whereas 11 (16%) had effusions that lasted longer than 14 days. Ten patients among prolonged effusion group (35%) had pulmonary atresia coexistent with the main diagnosis. Fontan operation was performed in 6 patients (8.7%) over the age of 10, and 4 of these patients (67%) had prolonged pleural effusion. Among numerous variables, statistical significance between the two groups was achieved in pre-operative mean pulmonary artery pressure, post-operative albumin, C-reactive protein levels, length of hospital stay, duration of chest tube drainage, and amount of effusion per day. Early recognition and treatment strategies with routine medical protocol use remain to be the cornerstone for the management of post-operative prolonged pleural effusions after Fontan surgery.

Pulmonary venous connections may be infrequently abnormal in patients with tetralogy of Fallot (TOF). A special subgroup of partial anomalous pulmonary venous return,"scimitar cyndrome", and its coexistence with TOF is less frequently reported. It may proceed unnoticed, as cyanosis already predominates in the clinical picture. This uncommon association must be kept in mind for patients with TOF who have an accessory flow in the inferior vena cava, especially when all pulmonary venous return to the left atrium is not clearly seen.

Although many anatomical variations may be encountered in children with double outlet right ventricle, coexistence of levo-malposed great vessels and left juxtaposed atrial appendages is uncommonly observed. This case report underlines the rarity of this anatomical combination and its clinical significance along with the surgical management in an infant.

Background: The persistence of palpitations in some patients after supraventricular tachycardia ablation is a common challenge despite high procedural success rates. Establishing a correlation between symptoms and tachycardia is especially crucial for adolescent patients, who face challenges in perceiving and articulating their symptoms. This study aimed to evaluate the significance and efficacy of external event recorders in detecting symptom-arrhythmia correlation in paediatric patients experiencing palpitations following successful supraventricular tachycardia ablation.Methods: Among the 1682 patients who underwent successful supraventricular tachycardia ablation at our center between 2013 and 2023, the study included those who met the following criteria: 1) diagnosed with atrioventricular nodal reentrant tachycardia, concealed accessory pathway, or focal atrial tachycardia (excluding substrates identifiable on surface electrocardiogram such as Wolff-Parkinson-White and Mahaim type preexcitations), 2) without CHD, 3) aged over 10 years (as this age is considered sufficient for reliable symptom reporting), and 4) presenting with palpitations post-ablation, with no supraventricular tachycardia detected on electrocardiogram or 24-hour Holter monitoring. Patient data were retrospectively reviewed from medical records.Results: Among a total of 104 patients reporting palpitations (15%), event recording data of 73 patients were available. Supraventricular tachycardia was documented in eight cases, whereas sinus tachycardia was detected in nine patients. Symptom-arrhythmia correlation was achieved in 23% of patients, nearly half of whom had supraventricular tachycardia recurrence. Patients reporting palpitations with recurrent supraventricular tachycardia episodes were analysed according to diagnostic subgroups. The recurrence rate in patients with palpitations was higher in the focal atrial tachycardia group compared to the others (33%).Conclusion: Despite successful ablation procedures, palpitations continue to pose a significant concern. To precisely explore the actual symptom-rhythm correlation, we advocate safe and effective utilisation of external event recorders in paediatric patients, particularly those with sporadic symptoms, as opposed to relying solely on electrocardiogram and Holter monitoring.

Prolonged pleural effusion (PPE) is a fairly common condition which has considerable impact on complicated and longer hospital stays in the process of adaptation to new physiology after Fontan surgery. Identifying the patient population which is prone to have pleural effusions is still seeking for an answer. The purpose of this study is to determine the variables that may predict PPE according to the data of 69 patients who underwent Fontan operation between June 2018 -December 2020 and survived to date. Prolonged pleural effusion was defined as the need for a chest tube for more than 7 days. Two patient groups (with prolonged effusion: PPE group and without prolonged effusion: Non-PPE) were compared in terms of pre, peri and postoperative variables. Moreover, the patients were subdivided into "high risk" and "low risk" groups ( high risk is defined by either of : PVR/SVR ratio> 0.3, mPAP>15 mmHg , VEDP >12 mmHg , TPG>10 mmHg, RPA or LPA Z-score <-2.00) based on the preoperative catheterization data. The most frequent main diagnosis was tricuspid atresia (n: 13, 19%). Among 69 patients, 28 (40%) had PPE whereas 11 (16%) had effusion that lasted longer than 14 days. Ten patients among PPE group (35%) had pulmonary atresia coexistent with the main diagnosis. Fontan operation was performed in 6 patients (8.7%) over the age of 10, and 4 of these patients (67%) had PPE, while in 2 patients PPE lasted longer than 14 days. The most common angiographically obtained "high risk" factor was elevated mPAP (4 patients-14%) in PPE group, and in 2 patients, both of whom had more than one risk factor, effusion lasted longer than 14 days. [Among numerous variables, statistical significance between two groups was achieved in preoperative mPAP; postoperative albumin, C reactive protein (CRP) levels, lenght of hospital stay, duration of chest tube drainage and amount of effusion per day]. As PPE increases the duration of hospital stay after Fontan operation, early recognition and treatment strategies with routinely used medical protocols remain to be the cornerstone for management of postoperative effusions.