Transpercutaneous closure of perimembranous ventricular septal defects by symmatric occluder

Background: Ventricular septal defect ( VSD ) is the most frequently occurring congenital cardiac disease, accounts nearly 15-30% of all cases. Surgery is still the corrective therapy with high success and low complication but having some problems with: cardiopulmonary bypass, anesthesia, ICU, sternalitis, chest scar, AV block... Recently many progress in cardiac intervention applied to treat congenital heart disease especially percutaneous VSD closure. Currently patients with VSD have other choice to cure safely, effectively and less complication. Objectives: To evaluate 12 months rusults from transpercutaneous closure of perimembranous VSD by modified double – disk symmatric devices ( symmatric occluder). Methods: This is the descriptive clinical trial and follow-up. Result: 41 patients selected by echocardiography, 37 patients were closed successfully (90,2% success rate). No significant complication (AVB…) and 1 patient nonsignificant shunt is 2.7% after 12 month follow-up. Conclusions: Transpercutaneous closure of perimembranous VSD by symmatric occluder is effective and safe and more, longer follow-up.

Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study

Background Neonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims. We here aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST). Methods Thirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and ≥ 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale. Results In total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% ≥5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 [28–69] vs. 24 [15–37]s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 [167–228] vs. 178 [138–234] and 720[538–818] vs. 660 [562–833]s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0). Conclusion Although difficulties in CVC-placement seem to relate to vessel size and patient’s weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care. Trial registration Wireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered.

The Optimal Tetralogy of Fallot Repair Using Generative Adversarial Networks

BackgroundTetralogy of Fallot (TOF) is a type of congenital cardiac disease with pulmonary artery (PA) stenosis being the most common defect. Repair surgery needs an appropriate patch to enlarge the narrowed artery from the right ventricular (RV) to the PA.MethodsIn this work, we proposed a generative adversarial networks (GANs) based method to optimize the patch size, shape, and location. Firstly, we built the 3D PA of patients by segmentation from cardiac computed tomography angiography. After that, normal and stenotic areas of each PA were detected and labeled into two sub-images groups. Then a GAN was trained based on these sub-images. Finally, an optimal prediction model was utilized to repair the PA with patch augmentation in the new patient.ResultsThe fivefold cross-validation (CV) was performed for optimal patch prediction based on GANs in the repair of TOF and the CV accuracy was 93.33%, followed by the clinical outcome. This showed that the GAN model has a significant advantage in finding the best balance point of patch optimization.ConclusionThis approach has the potential to reduce the intraoperative misjudgment rate, thereby providing a detailed surgical plan in patients with TOF.

Ivemark syndrome with obstructed supracardiac TAPVC- case report

Heterotaxy disorder is a disturbance in the usual left and right distribution of the thoracic and abdominal organs. Ivemark syndrome is one such heterotaxy disorder. It is a rare disorder which affects males more than females with majority of cases presenting in the neonatal period mainly due to complex congenital cardiac disease. Here is a case report of rare disorder of the neonate with Ivemark syndrome with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC). Management of obstructed supracardiac TAPVC is complicated as PGE1 infusion is contraindicated and immediate surgical correction is advised.