Introduction:Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical “printouts” Healthcare applications are currently in evolution.Objective:The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs).Materials and Methods:Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed.Results:Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning.Conclusions:3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.
The Warden technique is a simple and effective surgical option, which should be preferred for patients with anomalous drainage of the pulmonary veins to SVC. Though arrhythmias are rare in the early follow-up, longer follow-up is required to rule out their late development.
Background: Noninvasive respiratory support is often used in preventing postextubation respiratory failure in neonates and infants after cardiac surgery. Aim: We compared the efficacy of nasal Bilevel Positive Airway Pressure (N/BiPAP) with that of High- flow Nasal Cannula(HFNC) in prevention of post extubation respiratory failure and maintenance of gas exchange in neonates and infants undergoing cardiac surgery. The incidence of complications related to the use of these modes were also compared. Settings and Design: This is a retrospective review of medical records of patients in pediatric cardiac intensive unit of a high-volume center. Methods: A total of 100 patients who received noninvasive respiratory support postextubation were divided into N/BiPAP group and HFNC group. The two groups were compared for postextubation respiratory failure, gas exchange in arterial blood gas at 24 h of extubation, and incidence of complications, namely pneumothorax, abdominal distension, and device–interface-related pressure ulcers. Results: Fifty patients each received N/BiPAP and HFNC after extubation. Patients who received N/BiPAP were younger (2.68 ± 2.97 months vs. 6.94 ± 4.04 months, P = 0.001) and had longer duration of postoperative ventilation (106.98 ± 79.02 h vs. 62.72 ± 46.14 h, P = 0.001). The reintubation rates were similar (20% [ n = 10] in N/BiPAP group vs. 8% [ n = 4] in HFNC group, P = 0.074). The mean arterial PO 2 values at 24 h of extubation was 119.17 ± 56.07 mmHg for N/BiPAP group versus 123.32 ± 64.33 mmHg for HFNC group ( P = 0.732). Arterial PCO 2 values at 24 h were similar (43.97 ± 43.64 mmHg in N/BiPAP vs. 37.67 ± 4.78 mmHg in HFNC, P = 0.318). N/BiPAP group had higher incidence of abdominal distension (16% [ n = 8] vs. nil in HFNC group, P = 0.003) and interface-related pressure ulcers (86% [ n = 43] vs. 14% [ n = 7] P = 0.006). Conclusion: N/BiPAP and HFNC have comparable efficacy in preventing reintubation and maintaining gas exchange. HFNC has fewer complications compared to N/BiPAP.
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