Expectant management of pediatric lymphatic malformations: A 30-year chart review.

BACKGROUND: Lymphatic malformations (LM) are rare congenital lesions with varied clinical presentations, from asymptomatic to life-threatening. Regardless of initial presentation, many are treated aggressively either surgically or medically. There is a scarcity of literature regarding expectant management, this study compares current literature surrounding the outcomes of LMs managed conservatively to a provincial database in which conservative management was the primary treatment. METHODS: Retrospective chart review of all pediatric patients diagnosed with a lymphatic malformation in Newfoundland and Labrador between 1989-2019. In total, 43 patients were reviewed, 2 were excluded due to inadequate follow up, 1 was excluded due to initial life-threatening presentation requiring intervention. Of these patients, 32 were managed conservatively without any intervention, 7 surgically, and 1 aspirated. Data extracted included age at referral, management, complications, clinical regression and patient satisfaction, years of follow up, and recurrence rate. RESULTS: Patients managed expectantly had partial or complete clinical regression in 81%. Anecdotal regression as reported by patients and family was 84%. This is compared to a 45% clinical regression with expectant management in the literature and a recent systematic review with a 48% overall regression rate with sclerotherapy [10,12]. Average follow up was 6 years and average time to regression was 6.6 years. No major complications were reported. Recurrence rate in expectant management was 0% versus 21% in surgical group. CONCLUSIONS: Expectant management is a safe and viable alternative to more aggressive treatments and ultimately leads to regression in the majority of cases. It should be considered as first line for non-life-threatening lymphatic malformations.

The impact of COVID-19 on surgical education: perspectives from Canadian general surgery residents.

Most institutions have mitigated the impact of the COVID-19 pandemic on residency education by transitioning to web-based educational platforms and using innovative solutions, such as surgical video libraries, telehealth clinics, online question banks via social media platforms, and procedural simulations. Here, we assess the perceived impact of COVID-19 on Canadian surgical residency education and discuss the unique challenges in adapting to a virtual format and how novel training methods implemented during the pandemic may be useful in the future of surgical education.

Three-dimensional printing for assessment of paravalvular leak in transcatheter aortic valve implantation.

BACKGROUND: Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI. METHODS: Retrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram. RESULTS: One female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1-24.1 ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (- 4.6761,-3.2554), p < 0.001). CONCLUSIONS: Our experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.