In April 2024, Japan implemented new regulations that will be capping doctors’ overtime work hours, marking the full-scale launch of the “Work Style Reform for Doctors.” This marks a pivotal step toward revising the long-standing medical delivery system, which has relied heavily on excessive workloads, and in moving toward a sustainable and high-quality healthcare framework. Therefore, the 60th Annual Meeting of the Japanese Society of Pediatric Cardiology and Cardiac Surgery conducted a special session organized by the Committee on Work Style Reform entitled, “Rethinking Pediatric Cardiology in the Era of Diversity.” Herein, four institutions who have been actively implementing reformed initiatives, shared their practices, thereby sparking discussions on diverse approaches to achieving work–life balance for professionals in pediatric cardiovascular care. This study compiles the contributions from all presenters and offers a written record of the session’s insights. It aimed to re-examine physicians’ work styles, considering diversity promotion and gender equity in the clinical setting. Ensuring healthcare quality and safety requires a workplace in which everyone can continue to work without bearing unreasonable burdens. We envision a future in which various professionals can thrive in truly inclusive medical environments.

Various classification systems for ventricular septal defect (VSD) have been proposed. In this report, we provide an overview of the classification system for VSD proposed by the International Society for the Nomenclature of Pediatric and Congenital Heart Disease (ISNPCHD), which was presented upon request at the 21^st Educational Seminar. This classification is based on two complementary approaches: The Geographic approach (central, inlet, trabecular muscular, or outlet), which categorizes VSDs according to their anatomical location within the ventricular septum, and the Borders approach (perimembranous, muscular, or juxta-arterial), which classifies them based on the relationship between the defect margins and the surrounding anatomical structures. This system has been incorporated into the 11^th revision of the International Classification of Diseases (ICD-11). The combination of geographic and border approaches enables a more detailed anatomical characterization of VSDs.

A 4-year-old boy was diagnosed with idiopathic pulmonary arterial hypertension (IPAH) following edema and general fatigue. Despite the initiation of sildenafil (nitric oxide pathway drug) and Macitentan (endothelin pathway drug), pulmonary hypertension did not improve; thus, Selexipag, a drug that acts on the prostacyclin pathway, was added. However, its administration was discontinued due to chest pain. A positive acute pulmonary vasoreactivity test (AVT) with nitric oxide led to the introduction of a calcium channel blocker (CCB). After the CCB was introduced, selexipag was successfully reintroduced. Cardiac catheterization performed eight months after initiating treatment revealed remarkable improvement of the pulmonary arterial pressure and resistance. CCB efficacy has been reported in patients with IPAH having a positive AVT; however, there have been few reports on its efficacy in pediatric patients in Japan. We encountered a pediatric patient with IPAH who showed marked improvement with combination therapy, including CCB. Although CCB is not often administered for treating IPAH, it may be a useful option in some cases.