Pediatrics Spanish Registry of Percutaneous Melody Pulmonary Valve Implantation in Patients Younger Than 18 Years.

INTRODUCTION AND OBJECTIVES: A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. METHODS: Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. RESULTS: Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. CONCLUSIONS: Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication.

3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia.

OBJECTIVES: To evaluate whether three-dimensional (3D) printed models can be used to improve interventional simulation and planning in patients with aortic arch hypoplasia. BACKGROUND: Stenting of a hypoplastic transverse arch is technically challenging, and complications such as stent migration and partial obstruction of the origin of the head and neck vessels are highly dependent on operator skills and expertise. METHODS: Using magnetic resonance imaging (MRI) data, a 3D model of a repaired aortic coarctation of a 15-year-old boy with hypoplastic aortic arch was printed. Simulation of the endovascular stenting of the hypoplastic arch was carried out under fluoroscopic guidance in the 3D printed model, and subsequently in the patient. A Bland-Altman analysis was used to evaluate the agreement between measurements of aortic diameter in the 3D printed model and the patient's MRI and X-ray angiography. RESULTS: The 3D printed model proved to be radio-opaque and allowed simulation of the stenting intervention. The assessment of optimal stent position, size, and length was found to be useful for the actual intervention in the patient. There was excellent agreement between the 3D printed model and both MRI and X-ray angiographic images (mean bias and standard deviation of 0.36 ± 0.45 mm). CONCLUSIONS: 3D printed models accurately replicate patients' anatomy and are helpful in planning endovascular stenting in transverse arch hypoplasia. This opens a door for potential simulation applications of 3D models in the field of catheterization and cardiovascular interventions.

Three-dimensional patient-specific cardiac model for surgical planning in Nikaidoh procedure.

PURPOSE: To explore the use of three-dimensional patient-specific cardiovascular models using rapid prototyping techniques (fused deposition modelling) to improve surgical planning in patients with complex congenital heart disease. DESCRIPTION: Rapid prototyping techniques are used to print accurate three-dimensional replicas of patients' cardiovascular anatomy based on magnetic resonance images using computer-aided design systems. Models are printed using a translucent polylactic acid polymer. EVALUATION: As a proof of concept, a model of the heart of a 1.5-year-old boy with transposition of the great arteries, ventricular septal defect and pulmonary stenosis was constructed to help planning the surgical correction. The cardiac model allowed the surgeon to evaluate the location and dimensions of the ventricular septal defect as well as its relationship with the aorta and pulmonary artery. CONCLUSIONS: Cardiovascular models constructed by rapid prototyping techniques are extremely helpful for planning corrective surgery in patients with complex congenital malformations. Therefore they may potentially reduce operative time and morbi-mortality.