Background: Surgeon and cardiologist on their own cannot cope with patients needs, occasionally. Hypoplastic left heart syndrome witnessed the collaboration between them for a palliative, hybrid procedure. As a strategy, hybrid approach has been applied in several, unforeseeable settings. Our initial experience is presented, pointing at indications, shortcomings and mid-term results.

Methods: Fifty-one patients were scheduled for a hybrid procedure along five years. This was defined as close collaboration between surgeon and cardiologist working together in the same room, either cath-lab (26 patients) or theatre (25 patients)

Results: Five groups were arbitrarily defined. A: vascular cut-down in the cath-lab (17 neonates); B: bilateral banding (plus ductal stent) in hypoplastic left heart syndrome or alike (10 children); C: perventricular closure of muscular ventricular septal defect (9 cases); D: Balloon/stenting of pulmonary branches along with major surgical procedure (9 kids); E: surgical implantation of Melody valve (5 patients) and others (1 case). Two complications were recorded: left ventricular free wall puncture and previous conduit tearing. Both drawbacks were successfully sort out under cardiopulmonary by-pass.

Conclusion: Surgeon and cardiologist partnership can succeed where their isolated endeavors are not enough. Hybrid procedures keep on spreading, overcoming initial expectations. As a bridge to biventricular repair or transplant, bilateral banding plus ductal stent sounds interesting. Novel indications can be classified into different groups. Hybrid procedures are not complication-free.

A new and simple trick to encircle the Inferior Vena Cava (IVC) in minimally invasive cardiac surgery is depicted. With the aid of a shafted, flexible-tip dissector, the IVC is surrounded with a tape for its exclusion in a gentle movement.

ACTA2 (actin, alpha 2, smooth muscle) mutation associated with PDA aneurysm rarely presents with heart failure in neonates. Survival is poor with impaired quality of life due to strokes, aneurysms and thromboticischemic events.

We describe a neonate with ACTA2 mutation found to have a 3 cm arterial duct aneurysm (PDA) extending into the distal arch and proximal main pulmonary artery (MPA) with impaired left ventricular systolic function. She underwent excision of the aneurysm and repair of distal arch under deep hypothermic circulatory arrest (DHCA) with good immediate outcome.

A trichobezoar is a mass of cumulated hair within the gastrointestinal tract. Bezoars are rare in children. They are commonly found in stomach. Rarely, bezoars can be located in small bowel, which are most often located in the ileum. Intestinal obstruction due to trichobezor is extremely rare. In this case report we describe an atypical localization of trichobezoar in jejunum (76cm long) causing intestinal obstruction without a primary in stomach in 7 year girl which was managed successfully with surgery.

Splenogonadal fusion is a rare congenital abnormality. Preoperative diagnosis is difficult but can be based on scintigraphy using technetium 99m. It’s a benign lesion that remains to be differentiated from a testicular tumor.

In most cases, the splenic tissue can be dissected of the gonadal structures easily, and if there are any doubts concerning the nature of the swelling, an intraoperative frozen section can be performed to avoid an unnecessary orchiectomy.

We report the case of a 4-year-old child in whom a scrotal mass indicated many investigations before a surgical exploration, and in whom the surgical specimen was diagnosed histologically as a splenogonadal fusion.