Michael Argilla

Utility and Scope of Rapid Prototyping in Patients with Complex Muscular Ventricular Septal Defects or Double-Outlet Right Ventricle: Does it Alter Management Decisions?

Rapid prototyping facilitates comprehension of complex cardiac anatomy. However, determining when this additional information proves instrumental in patient management remains a challenge. We describe our experience with patient-specific anatomic models created using rapid prototyping from various imaging modalities, suggesting their utility in surgical and interventional planning in congenital heart disease (CHD). Virtual and physical 3-dimensional (3D) models were generated from CT or MRI data, using commercially available software for patients with complex muscular ventricular septal defects (CMVSD) and double-outlet right ventricle (DORV). Six patients with complex anatomy and uncertainty of the optimal management strategy were included in this study. The models were subsequently used to guide management decisions, and the outcomes reviewed. 3D models clearly demonstrated the complex intra-cardiac anatomy in all six patients and were utilized to guide management decisions. In the three patients with CMVSD, one underwent successful endovascular device closure following a prior failed attempt at transcatheter closure, and the other two underwent successful primary surgical closure with the aid of 3D models. In all three cases of DORV, the models provided better anatomic delineation and additional information that altered or confirmed the surgical plan. Patient-specific 3D heart models show promise in accurately defining intra-cardiac anatomy in CHD, specifically CMVSD and DORV. We believe these models improve understanding of the complex anatomical spatial relationships in these defects and provide additional insight for pre/intra-interventional management and surgical planning.

Iatrogenic Aortopulmonary Window and Pulmonary Artery Dissection Secondary to Aortic Cannulation

We present a case of a 23-year-old man with Shone’s complex, including bicuspid aortic valve, coarctation of the aorta status post neonatal repair and subsequent stent placement, mitral valve stenosis status post valve repair, and eventual replacement 1 year before the current presentation. A noncontrast thoracic computed tomography scan was performed after his mitral valve replacement to investigate a persistent pleural effusion. The scan revealed an unusual area of high and low attenuation within the proximal pulmonary arterial system, and a contrast-enhanced computed tomography study was recommended for additional evaluation. However, given that the patient was asymptomatic with unremarkable physical examination, follow-up study was not performed until ≈1 year later when he was noted with a new continuous murmur on physical examination and an echocardiogram revealed continuous flow arising from the distal ascending aorta into the pulmonary artery on two-dimensional color Doppler (Figures 1A …

Asymptomatic giant coronary aneurysm in an adolescent with Behcet's syndrome

ObjectiveBehcets is an idiopathic multi-organ syndrome, which may have onset during childhood. Vascular involvement is uncommon, with rarely reported coronary aneurysm formation. We present a case report of a teenager girl who developed recalcitrant life-threatening Behcets vasculitis, involving both small and large venous and arterial systems including a giant coronary aneurysm.Case reportDe-identified data were collected retrospectively in case report format. Although our sixteen year old female with Behcets vasculitis had resolution of many arterial aneurysms, she had persistent venous thrombosis of large vessels, as well as persistent, giant arterial aneurysms requiring intra-arterial coiling of a lumbar artery and coronary bypass grafting despite intensive immunosuppression including glucocorticoids, cyclophosphamide, infliximab, methotrexate, azathioprine and intravenous immunoglobulin.ConclusionsVascular manifestations may be seen in Behcets syndrome, including asymptomatic coronary aneurysm, which may be refractory to immunosuppression and ultimately require surgical intervention. Increased awareness is essential for prompt diagnosis and management.

Multimodality imaging of scimitar syndrome in adults: A report of four cases

Partial anomalous pulmonary venous return (PAPVR) comprises a group of congenital cardiovascular anomalies associated with pulmonary venous flow directly or indirectly into the right atrium. Scimitar syndrome is a variant of PAPVR in which the right lung is drained by right pulmonary veins connected anomalously to the inferior vena cava. Surgery is the definitive treatment for scimitar syndrome. However, it is not always necessary as many patients are asymptomatic, have small left‐to‐right shunts, and enjoy a normal life expectancy without surgery. We report multimodality imaging in four adults with scimitar syndrome and the implications for management of this rare syndrome.

Novel use of an ultrafiltration device as an alternative method for fluid removal in critically ill pediatric patients with cardiac disease: a case series

Fluid overload (FO) is a common complication for pediatric patients in the intensive care unit. When conventional therapy fails, hemodialysis or peritoneal dialysis is classically used for fluid removal. Unfortunately, these therapies are often associated with cardiovascular or respiratory instability. Ultrafiltration, using devices such as the Aquadex™ system (Baxter Healthcare, Deerfield, IL, USA), is an effective tool for fluid removal in adult patients with congestive heart failure. As compared to hemodialysis, ultrafiltration can be performed using smaller catheters, and the extracorporeal volume and minimal blood flow rates are lower. In addition, there is no associated abdominal distension as is seen in peritoneal dialysis. Consequently, ultrafiltration may be better tolerated in critically ill pediatric patients. We present three cases of challenging pediatric patients with FO in the setting of congenital heart disease in whom ultrafiltration using the Aquadex™ system was successfully utilized for fluid removal while cardiorespiratory stability was maintained.

PATIENT-SPECIFIC SIMULATION OF RIGHT VENTRICLE OUTFLOW TRACT CONDUIT BALLOON ANGIOPLASTY USING CARDIAC MRI-DERIVED 3D VIRTUAL MODELS TO ASSESS THE RISK OF CORONARY ARTERY COMPRESSION DURING TRANSCATHETER PULMONARY VALVE REPLACEMENT

Transcatheter pulmonary valve replacement (TPVR) with the Melody™ valve is frequently considered in patients with right ventricular outflow tract (RVOT) conduit obstruction. TPVR carries a risk of coronary artery (CA) compression. This risk is evaluated by CA angiography and simultaneous balloon

A Unique ALCAPA Variant in a Neonate

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly present in approximately one in 300,000 live births. Here, we present a unique ALCAPA variant identified in a neonate. The left anterior descending artery originated posterolaterally on the main pulmonary artery, and the circumflex originated separately from the distal right pulmonary artery. doi: 10.1111/jocs.12079 (J Card Surg 2013;28:306–308)