ObjectivesTo assess the communication potential of three-dimensional (3D) patient-specific models of congenital heart defects and their acceptability in clinical practice for cardiology consultations.DesignThis was a questionnaire-based study in which participants were randomised into two groups: the ‘model group’ received a 3D model of the cardiac lesion(s) being discussed during their appointment, while the ‘control group’ had a routine visit.SettingOutpatient clinic, cardiology follow-up visits.Participants103 parents of children with congenital heart disease were recruited (parental age: 43±8 years; patient age: 12±6 years). In order to have a 3D model made, patients needed to have a recent cardiac MRI examination; this was the crucial inclusion criterion.InterventionsQuestionnaires were administered to the participants before and after the visits and an additional questionnaire was administered to the attending cardiologist.Main outcome measuresRating (1–10) for the liking of the 3D model, its usefulness and the clarity of the explanation received were recorded, as well as rating (1–10) of the parental understanding and their engagement according to the cardiologist. Furthermore, parental knowledge was assessed by asking them to mark diagrams, tick keywords and provide free text answers. The duration of consultations was recorded and parent feedback collected.ResultsParents and cardiologists both found the models to be very useful and helpful in engaging the parents in discussing congenital heart defects. Parental knowledge was not associated with their level of education (p=0.2) and did not improve following their visit. Consultations involving 3D models lasted on average 5 min longer (p=0.02).ConclusionsPatient-specific models can enhance engagement with parents and improve communication between cardiologists and parents, potentially impacting on parent and patient psychological adjustment following treatment. However, in the short-term, parental understanding of their child's condition did not improve.

BackgroundAn interdisciplinary framework including a narrative element could allow addressing lack of awareness or excessive anxieties and teasing out divergences between patients’ health status and their expectations. This could be particularly relevant for adolescents with congenital heart disease (CHD).ObjectiveTo develop a collective narrative ensuing from a creative activity involving adolescents with CHD, in order to explore their health perceptions and expectations.DesignArtist-led workshop process supported by a multidisciplinary team.Setting and participantsYoung people with CHD (n=5, age 17–18 years, two men) were involved in the creative process, which encouraged them, over two sessions, to elaborate imagery relating to their uniqueness as individuals and their hearts. On top of creative activities (including self-portraits, embossing, body mapping and creative writing), participants were also shown their hearts in the form of cardiovascular MRIs and three-dimensional (3D) models manufactured by means of 3D printing.MethodsA composite first-person narrative approach was adopted to handle the emerged phenomenological descriptions and creative outputs, in order to shape a unified story.ResultsThe composite first-person narrative highlighted themes central to the patients, including their interpretation of medical references, their resilience and their awareness of anatomical complexity.Discussion and conclusionsExploring the narrative of adolescents with CHD can offer unique insight into the way they view their hearts at a crucial stage of their care. An artist-led creative workshop supported by a multidisciplinary team can be a valuable approach to collect such narratives from patients and begin exploring them.

An arts workshop investigated the process of communicating the notion of uniqueness with young people with congenital heart disease (CHD) and whether threedimensional (3D) visualization could be more effective than two-dimensional (2D) visualization for elaborating CHD anatomy and increasing awareness. Young people with CHD (n=7, 14–18 years old) were invited to a workshop by a multidisciplinary team (a visual artist, a bioengineer, two psychologists and an adolescent clinical nurse specialist). The artist guided the participants through self-portrait exercises, creative writing, painting a body map, discussions and reflections. Participants also discussed a range of 3D-printed heart models. Participants unanimously agreed that a 3D-sculpted self-portrait form was more immediate than a 2D portrait form for representing themselves. Body maps provided insight into their inner landscape. In discussing 3D heart models, different preferences emerged, at times contrasting or even opposed. The quality of engagement was excellent throughout. An interdisciplinary approach can be successfully used to explore the potentially sensitive theme of uniqueness in CHD.

We present a case of severe acute kidney injury (AKI) occurring shortly after the initiation of dronedarone therapy, which we suspect was the result of an adverse drug reaction. The mechanism of AKI cannot be definitively determined. The most probable mechanism however involves dehydration secondary to diarrhoea, and medications causing hypotension, both precipitating AKI, further exacerbated by reduced excretion of medications reducing tissue perfusion. This case adds to the growing number of reports submitted to pharmacovigilance authorities regarding the association between dronedarone and AKI. It serves as a reminder of the risks of cardiovascular polypharmacy likely to be prevalent in patients considered for dronedarone (which causes diarrhoea as a common side-effect).

Introduction: Communication in medical consultations is recognised as an important factor in optimising patient satisfaction and health outcomes. Patient-specific (PS) plastic models of congenital heart lesions may offer benefits for education and communication purposes. This study aimed to quantitatively test the translational potential of PS models in a systematic manner. Methods: Parents of children with congenital heart defects (n=97), matched for age, sex and level of education, were divided into Group I (n=52) for normal consultations/follow-up visits, and Group II (n=45) where PS models generated from magnetic resonance imaging and printed in white nylon with rapid prototyping machine model were additionally used. Participants and cardiologists completed rating scales (scored from 0-10) to assess parents’ knowledge of their child’s condition before and after the consultation and to provide feedback on any tools used, including the 3D model. Results: Clinicians reported that the models were very useful (8.8±1.1/10), encouraged parent interaction (9.1±1.4/10), and did not lengthen consultation (93% cases), although these lasted 5 minutes longer (p=0.02). Parents rated PS models as very useful (9.5±0.7/10) and more informative than medical images, with 73% explicitly asking to keep their model. Parents in both groups equally felt their understanding improved following their visit, although when their questionnaires were rated blindly by two cardiologists only 5 participants per group were actually found to demonstrate improved understanding. In 40% of cases the cardiologists were not able to gather even the primary diagnosis based on the information provided by parents after their consultation. Conclusions: Patients’ parents and clinicians found PS models to be useful communication tools, although parents’ understanding appears to be mainly related to their prior level of knowledge. Clinicians found PS models useful in explaining congenital heart defects and encouraging parent interaction. Use of such a modality during the first interactions with parents may have benefits for improving parents’ participation in their child’s management.