We describe a male infant, seen at the age of 10 days, with a very rare form of vascular ring. The aortic arch was left-sided, but the aorta descended on the right, with a right-sided persistently patent arterial duct associated with interruption of the aortic arch and presence of Abbott’s artery. We performed end-to-side anastomosis of the descending aorta to the ascending aorta, divided the Abbott’s artery and the right-sided arterial duct, and banded the pulmonary trunk. Despite our best efforts, the patient died on the eighth day after the surgical intervention.

The problems that exist in maintaining a partnership in paediatric cardiac surgery are considerable. They relate to fairness in allocation of time for leisure, the apportioning of cases between the partners, internal competition between them, financial considerations, and promotion of the ego. In this review, we discuss our own experiences in maintaining a partnership over a period of more than 18 years, relating such a “virtuous partnership” to the writings of Plato and Aristotle, and setting it against the tenets of the ancient Greek polis.

The polis, or city state, came to prominence in ancient Greece during the golden age of Pericles, this period seeing the initial evolution of Western philosophy, as well as numerous other scientific, artistic and architectural advances. The concept of the polis was to create a natural association with its citizens that nurtured all that is best in people, at the same time defining their character. In this respect, according to Plato, the person and the polis are mirror images. Aristotle then expanded this notion to incorporate the various forms of friendship, which he pointed out last only as long as the interrelated pleasure survives.

Using these principles as the point of departure, we argue that cardiac surgeons should respect moral virtue in each other. Extending this process means that we should also respect, and celebrate, our relationships with affiliated physicians, nurses, perfusionists, administrators, and all concerned in the care of children with congenitally malformed hearts. In this way, we create a virtuous partnership for congenital cardiac surgery that promotes all that was good, as engendered in the ancient Greek polis.

As we extend these observations to the modern world, we discuss some of the features that have permitted us to work so well together. One of the most important is a summoning and unwritten tenet that greets us as we enter the operating room, namely “check your ego at the door”. The operative choice should always be dictated by discussion, citations of literature, considered opinions, and relevance to the particular patient. Continuity of care should lead inexorably to the paediatric intensive care unit, where collegial relationships should be maintained with all those working therein. We need to recognize that there are various “captains of the ship”, who must work in harmony so as to bring the best possible care to our patients. We always endeavour to empower others to act on our behalf, based on their experience and training.

Whether we have achieved our desired moral excellence, and produced the completed or perfected friendship, is for others to judge. From our stance, we believe we have created a favourable environment by hard work, unselfish attitudes, and celebration of our mutual accomplishments. We were not the first to forge this kind of professional association, and happily we will not be the last.

We report the very unusual perforation of the mitral valve in the setting of Sweet's syndrome, or acute febrile neutrophilic dermatosis, in a boy aged 5 years. Surgical repair was uneventful, and follow-up showed no residual anomalies. Acute or delayed valvitis, with damage to either the mitral or aortic valves, should be screened for in this rare disease.

A male patient with congenitally corrected transposition, with no associated cardiac malformations, was diagnosed in childhood and followed until his death at age 28. He underwent two cardiac gated single photon emission computed tomographies over a two year period, which demonstrated progression of ischaemia and reduction of systolic function. The findings suggest that, when the systemic ventricle is perfused by the morphologically right coronary artery, there may be inadequate perfusion to supply any subsequent extensive hypertrophy.

Partially anomalous pulmonary venous connection of a solitary pulmonary vein in the setting of an intact atrial septum is often subclinical, and the indications for surgical repair are controversial. Here we describe a patient who developed a significant shunt over a period of 10-years. Flow through the anomalously connected pulmonary segment depends on the difference of pressure between the right and left atrium, and may increase with age.

Williams' syndrome is a rare condition that is associated with severe cardiovascular manifestations. We report a patient with Williams' syndrome who also has isolated obstruction of the right ventricular infundibulum, an association that, to the best of our knowledge, has not been previously reported.

Atrial septostomy has improved haemodynamics and clinical symptoms in selected patients with idiopathic pulmonary arterial hypertension. We found that, in 5 patients with idiopathic pulmonary arterial hypertension, septostomy resulted in decreased levels of brain-type natriuretic peptide, and improvement in symptoms of cardiac failure, suggesting that serial measurements of the peptide may have clinical utility.

Professionals working in the arena of health care face a variety of challenges as their careers evolve and develop. In this review, we analyze the role of mentorship, learning curves, and balance in overcoming challenges that all such professionals are likely to encounter. These challenges can exist both in professional and personal life.

As any professional involved in health care matures, complex professional skills must be mastered, and new professional skills must be acquired. These skills are both technical and judgmental. In most circumstances, these skills must be learned. In 2007, despite the continued need for obtaining new knowledge and learning new skills, the professional and public tolerance for a “learning curve” is much less than in previous decades. Mentorship is the key to success in these endeavours. The success of mentorship is two-sided, with responsibilities for both the mentor and the mentee. The benefits of this relationship must be bidirectional. It is the responsibility of both the student and the mentor to assure this bidirectional exchange of benefit. This relationship requires time, patience, dedication, and to some degree selflessness. This mentorship will ultimately be the best tool for mastering complex professional skills and maturing through various learning curves. Professional mentorship also requires that mentors identify and explicitly teach their mentees the relational skills and abilities inherent in learning the management of the triad of self, relationships with others, and professional responsibilities.

Up to two decades ago, a learning curve was tolerated, and even expected, while professionals involved in healthcare developed the techniques that allowed for the treatment of previously untreatable diseases. Outcomes have now improved to the point that this type of learning curve is no longer acceptable to the public. Still, professionals must learn to perform and develop independence and confidence. The responsibility to meet this challenge without a painful learning curve belongs to both the younger professionals, who must progress through the learning curve, and the more mature professionals who must create an appropriate environment for learning.

In addition to mentorship, the detailed tracking of outcomes is an essential tool for mastering any learning curve. It is crucial to utilize a detailed database to track outcomes, to learn, and to protect both yourself and your patients. It is our professional responsibility to engage in self-evaluation, in part employing voluntary sharing of data. For cardiac surgical subspecialties, the databases now existing for The European Association for CardioThoracic Surgery and The Society of Thoracic Surgeons represent the ideal tool for monitoring outcomes. Evolving initiatives in the fields of paediatric cardiology, paediatric critical care, and paediatric cardiac anaesthesia will play similar roles.

A variety of professional and personal challenges must be met by all those working in health care. The acquisition of learned skills, and the use of special tools, will facilitate the process of conquering these challenges. Choosing appropriate role models and mentors can help progression through any learning curve in a controlled and protected fashion. Professional and personal satisfaction are both necessities. Finding the satisfactory balance between work and home life is difficult, but possible with the right tools, organization skills, and support system at work and at home. The concepts of mentorship, learning curves and balance cannot be underappreciated.

Manipulation of an implanted pacemaker by the patient is a rare cause of malfunction, especially in children. We describe a child who inadvertently rotated his pacemaker under the skin, knotting the leads and dislodging them from the heart, leading to syncope and heart block. Our experience with this case underscores the need to consider this diagnosis in children as well as in adults if this problem is to be averted.

Defects of the oval fossa usually occur as isolated malformations, but can show an autosomal dominant pedigree in familial cases. Several mutations have been described for the transcription factor NKX2-5, and co-segregate with varied cardiac anomalies. We have identified by sequence analysis a novel missense heterozygous mutation in the NKX2-5 gene, specifically a substitution of glutamine for proline at codon 160, in a Moroccan family, the affected members having a deficiency of the floor of the oval fossa and atrioventricular block.

Cardiac malformations are very rare in which the great arteries arise from their appropriate ventricles, but are abnormally related to each other. Here, we present a patient with mirror-imaged atrial arrangement and a left-sided heart who has parallel arterial trunks with discordant atrioventricular and concordant ventriculo-arterial connections. The ventricles were related in supero-inferior fashion, the left ventricle being anterior and superior, this being an additional feature which, to the best of our knowledge, has not previously been described in this setting.

We discuss a 9-month-old male baby, submitted to surgery for correction of aortic coarctation, who showed severe bronchospasm, hypoxaemia, and cardio-respiratory arrest, and who died on the fifth postoperative day. The autopsy revealed histological signs of severe pulmonary vasoconstriction, possibly as a consequence of hypoxaemia secondary to bronchiolitis due to infection with the respiratory syncytial virus. This supposition was confirmed when viruses were detected in pulmonary tissue by immunohistochemistry and electron microscopy.