Bennett P. Samuel

Integration of Computed Tomography and Three-Dimensional Echocardiography for Hybrid Three-Dimensional Printing in Congenital Heart Disease.

Three-dimensional (3D) printing is an emerging technology aiding diagnostics, education, and interventional, and surgical planning in congenital heart disease (CHD). Three-dimensional printing has been derived from computed tomography, cardiac magnetic resonance, and 3D echocardiography. However, individually the imaging modalities may not provide adequate visualization of complex CHD. The integration of the strengths of two or more imaging modalities has the potential to enhance visualization of cardiac pathomorphology. We describe the feasibility of hybrid 3D printing from two imaging modalities in a patient with congenitally corrected transposition of the great arteries (L-TGA). Hybrid 3D printing may be useful as an additional tool for cardiologists and cardiothoracic surgeons in planning interventions in children and adults with CHD.

Ultrasound-Derived Three-Dimensional Printing in Congenital Heart Disease

Three-dimensional printing technology has significant clinical implications for the management of congenital heart disease. Computed tomography and magnetic resonance imaging have been established as imaging tools for the creation of physical three-dimensional models. The potential use of non-invasive bedside imaging techniques such as three-dimensional echocardiography to derive three-dimensional printed models can revolutionize the planning of interventions for complex congenital malformations. The feasibility of deriving three-dimensional printing from ultrasound provides an additional cost-effective and patient-centered option for interventional cardiologists and surgeons for the management and care of congenital heart disease patients.

Hybrid 3D printing: a game-changer in personalized cardiac medicine?

Three-dimensional (3D) printing in congenital heart disease has the potential to increase procedural efficiency and patient safety by improving interventional and surgical planning and reducing radiation exposure. Cardiac magnetic resonance imaging and computed tomography are usually the source datasets to derive 3D printing. More recently, 3D echocardiography has been demonstrated to derive 3D-printed models. The integration of multiple imaging modalities for hybrid 3D printing has also been shown to create accurate printed heart models, which may prove to be beneficial for interventional cardiologists, cardiothoracic surgeons, and as an educational tool. Further advancements in the integration of different imaging modalities into a single platform for hybrid 3D printing and virtual 3D models will drive the future of personalized cardiac medicine.

Regression of massive cardiac rhabdomyoma on everolimus therapy

Cardiac rhabdomyoma is the primary feature of the genetic disease, tuberous sclerosis complex, the most common cardiac tumor diagnosed in neonates and infants. Spontaneous regression is observed in most cases, but these tumors may cause hemodynamic instability, arrhythmias or other complications. We describe the case of a critically ill neonate, resuscitated after cardiac arrest secondary to massive locally invasive cardiac rhabdomyoma, who was successfully treated with everolimus (mammalian target of rapamycin [mTOR] inhibitor). Rapid tumor regression was observed on echocardiography, but it was unlikely that it was confounded by the natural disease course of regression. The presented case suggests that mTOR inhibitors may play a significant role in the treatment of large cardiac rhabdomyomas in critically ill neonates.

Surgical Treatment of Neonate With Congenital Left Main Coronary Artery Atresia

Left main coronary artery atresia (LMCAA) is a rare congenital malformation with a nonspecific and varied clinical presentation. Ventricular dysfunction and mitral insufficiency are expected ischemic consequences in the neonatal period. Left internal mammary artery (LIMA) bypass grafting (CABG) is uncommon because of the technical difficulties in performing this procedure in neonates. We describe LMCAA revascularization with a LIMA graft and mitral valve repair in a 7-week-old neonate with successful outcome 1 year postoperatively.

What Nurses Need to Know About Fecal Microbiota Transplantation: Education, Assessment, and Care for Children and Young Adults

Fecal microbiota transplantation (FMT) is an emerging experimental therapy for treatment of recurrent Clostridium difficile infection. In the future, FMT has the potential to be a treatment modality in other diseases that involve gut dysbiosis. As use of FMT is likely to expand, pediatric nurses need a clear understanding of FMT to provide appropriate education, assessment, and care for these patients. Pediatric research and clinical nurses are a resource to help children and parents understand the procedure. Important topics include donor screening, patient assessment before, during, and after treatment; routes of administration and positioning; preparation for discharge and followup evaluation.

Pulmonary Arteriovenous Malformations in Dyskeratosis Congenita

Pulmonary arteriovenous malformations (PAVMs) are rare lesions known to cause cyanosis due to abnormal communication between the pulmonary arteries and veins. They are commonly seen in association with hereditary hemorrhagic telangiectasia, congenital heart disease, hepatopulmonary syndrome, and portopulmonary shunting, but rarely in patients with dyskeratosis congenita (DC). We describe a patient previously diagnosed with DC confirmed to have microscopic PAVMs after bone marrow transplantation and discuss possible pathogenic mechanisms.

Biventricular Repair of Pulmonary Atresia After Fontan Palliation

Fontan palliation is used when biventricular repair (BVR) is not possible. Early outcomes are acceptable; however, the long-term sequelae include protein-losing enteropathy, declining functional status, increased pulmonary vascular resistance, heart failure, and hepatic and renal dysfunction. These adverse events are characteristic of persistent venous hypertension and may be avoided if restoring biventricular circulation is possible. Arrhythmias are a common adverse event, particularly in patients with an atriopulmonary connection, which may lead to acute decompensation and early death. We describe a 30-year-old woman who underwent successful BVR for pulmonary atresia with intact ventricular septum and demonstrate that where favorable anatomy exists with a failing Fontan, BVR should be considered.

Transcatheter Intervention in Cor Triatriatum Sinister

Cor triatriatum sinister is a rare condition caused by a membrane in the left atrium, resulting in left ventricular inflow obstruction. This developmental anomaly is usually diagnosed in childhood. However, a rare presentation during adulthood is observed when the membrane is incomplete. Surgical excision of the membrane is the first line of treatment. We present a 51-year-old woman who underwent successful transcatheter balloon dilation with complete loss of the membrane waist and hemodynamic and symptomatic improvement.

Creation of a 3D Printed Model: From Virtual to Physical

The assessment and management of children and adults with congenital heart disease (CHD) heavily relies upon accurate imaging of the morphology and interrelationships between the cardiac structures. The advent of three-dimensional (3D) printing has allowed for virtual imaging to be printed into tangible models for individualized care. 3D printed heart models have now gained acceptance in cardiac medicine as an additional tool for detailed surgical and interventional planning, especially in corrected or palliated complex CHD. The source datasets for 3D printing include computed tomography, cardiac magnetic resonance, and 3D echocardiography. The settings for image acquisition are critical for high-quality and accurate 3D printed models. Moreover, as each imaging modality has different strengths, integration of the best aspects for hybrid 3D printing may improve the accuracy of the heart models. The components of the heart derived from imaging modalities are segmented by semi-automated methods on dedicated post-processing software followed by 3D rendering. The 3D rendered virtual model is converted into a physical model on a 3D printer. The contribution of experts with in-depth knowledge of cardiac morphology is vital for every step involved in the creation of an accurate 3D model of the heart. The 3D printed model may be useful for teaching patients and family members as well as other medical professionals. As 3D printed heart models are a static representation of a dynamic organ, the functional and hemodynamic characteristics are lost. The visualization of 3D virtual dynamic heart models on a 3D platform with augmented reality will define the future of personalized cardiac medicine.