Nasib Kabbani is a fresh graduate from AlFaisal University.

Children undergoing cardiac surgery or catheter intervention may develop brady arrhythmia and heart block immediatelyrnafter intervention or surgery. Majority of the time, the slow cardiac rhythm is transitional and recovers within one torntwo weeks post intervention if no recovered permanent pacemaker insertion is usually indicated. On rare occasions, therernare children who develop late heart block after initial period of normal rhythm. This type of rare presentation is called laternpresenting heart block. We encountered three cases of late presenting heart block, two after AVSD repair appearing at two and sixrnyears post-surgical repair respectively. The third casernwas life threatening complete heart block appearingrnone week after VSD device closure. All cases had arnnormal sinus rhythm when they were dischargedrnhome following initial surgery or intervention butrnsubsequently developed late presenting heart blockrnwith significant clinical symptoms and in one casernlife threatening condition. This complication thoughrnrare but clinician need to be aware about it and mayrnwarrant follow up at least annual of the post-surgicalrnor interventional pediatric cardiac cases withrnperiodic ECG screening for long term follow up.

Senka Mesihović-Dinarević was born in 1958-Sarajevo.Faculty of Medicine Sarajevo 1982. 1982-2016 worked at the Paediatric Clinic-Clinical University CentrernSarajevo.Msc 1985,paediatrician age 30, subspeciality in paediatric cardiology: Sarajevo, Belgrade, London. PhD 1991, Professor of Paediatrics 2006. 1994.rnmember of AEPC, 1995. BPCA.1995-2011, lecturer: London MRCP. 2003-2016 Director of Pediatric Clinic.2000 FESC, 2008 of Academy of Sciences and Arts ofrnBosnia and Herzegovina, 2009. chairman of the Committee of Cardiovascular pathology. Honorary Doctorate of Letters, Cambridge England 2014. 2016. Memberrnof the European Academy of Science and Arts; over 477 papers, cited 218 times in the ICI Web of Science.

Cardiovascular disease atherosclerosis is interdisciplinary problem in which treatment included are: Cardiologist, paediatricrncardiologist, neurologist, diabetologist, endocrinologist, cardiac and vascular surgeons, neurosurgeon, radiologist,rnspecialist of nuclear medicine, epidemiologist, nutricionist, pathologist, biochemist, physicin and paediatricin family doctors.rnAtherosclerosis is now one of the leading causes of death in developed countries. Begins in childhood, long time withoutrndeveloping symptoms increases with age and about 50 years of age begins to seriously threaten. The most important risk factorsrnfor the development of atherosclerotic disease are: Hyperlipidemia, hypertension, smoking, diabetes, high fibrinogen, a malernsex at younger and middle age, and menopause in women taking oral contraceptives or hormone replacement therapy onlyrnwith presence of other risk factors, excessive weight, increased level of homocysteine, physical inactivity, heredity and immunernresponse in some diseases. Approximately 60-85% of obese children become obese adults, leading to earlier and more frequentrnoccurrence of chronic non-communicable diseases: hypertension, early atherosclerosis, diabetes mellitus type 2 and other.rnCardiovascular disease stays as the predominant cause of mortality and morbidity in develop countries. Primary preventionrnshould begin as early as possible, even in childhood, creating a healthy diet, no smoking, regular physical activity, which will bernable to prevent or at least slow the development of atherosclerosis. Preventive strategy of cardiovascular disease comprises thernfollow up of subjects in the major population by which we identify factors which could effect on cardiovascular risk, as well asrnthe type of strategy in promotion of cardiovascular health in years to come.