Natalie Soszyn

Background: In patients with functionally univentricular circulations, the flow restriction achieved by modifying microvascular plugs (MVPs) during percutaneous stage I palliation has not been widely quantified. This study evaluates how progressive modification of the polytetrafuoroethylene (PTFE) membrane of MVPs alters flow restriction using a bench-top model of uni-ventricular physiology. Methods: A 3D-printed model mimicking branch pulmonary arteries in parallel with a systemic outflow was connected to a Harvard pulsatile pump. Two MVP-9Q devices, each modified with one, two, three, or four slits in the PTFE membrane, were placed in limbs representing left and right pulmonary arteries. Mathematical scaling produced a valid hemodynamic model matching neonatal univentricuar physiology. Flow (L/min) was measured using sensors placed on both pulmonary arteries and the systemic limb. Flow distribution between systemic and pulmonary limbs was calculated as a percentage of fixed total flow to determine the pulmonary (Qp) to systemic (Qs) flow ratio (Qp:Qs). Results: With a baseline model representing 2:1 Qp:Qs ratio, MVPs with one slit reduced pulmonary flow (Qp) by 23%. Two slits reduced Qp by 21% and produced a Qp:Qs ratio closest to 1:1. Additional slits progressively increased Qp and reduced restriction (three-slits: 18% reduction, Qp:Qs 1.1:1; four-slits: 15% reduction, Qp:Qs 1.3:1). Conclusions: Incremental PTFE membrane modification generated proportional but nonlinear effects on flow distribution in a simulated univentricular circulation. Creating one or two slits provided the optimal balance between pulmonary and systemic flow, while more than two slits produced minimal restriction.

Since 2014, transcatheter paravalvular leak closure with the Occlutech Paravalvular Leak Device has been successfully accomplished in adults with high technical success. We describe the first successful use of the Occlutech Paravalvular Leak Device in the left atrio-ventricular valve in the United States in a 5-year-old child with a history of previously repaired atrio-ventricular septal defect.

Purpose of Review Our goal of this review is to describe the current evidence and future applications of virtual reality (VR) from echocardiographic acquired images to enhance diagnostic accuracy and improve the visualization of cardiac structures by providing immersive 3-dimensional (3D) environments for better interpretation, communication between healthcare providers, families and trainees. Recent Findings Virtual reality is a powerful tool for education, procedural planning and simulation. Using readily available echocardiographic images for this purpose is feasible, effective and safe. Summary This document highlights the increasing role of VR in procedural planning, education, and intraprocedural guidance using three-dimensional echocardiography (3DE). Key advancements include the development of smaller 3D transthoracic and pediatric transesophageal probes with better temporal resolution, which enable enhanced imaging for preoperative planning. VR allows surgeons to visualize dynamic 3D cardiac models created from echocardiographic or Computed Tomography (CT) data, enabling better pre-surgical rehearsal, device selection, and landing zone visualization. It also provides immersive training tools for echocardiographers and offers potential for intraprocedural guidance in interventions such as atrial septal defect closures. These developments underscore the growing synergy between VR and 3DE for refining diagnosis and procedural strategies.

We present the case of 53-year-old woman with a late diagnosis of an right pulmonary artery-left atrium fistula who underwent transcatheter device closure using multi-modality imaging for pre-procedural planning and procedural guidance.

Recent advances in available percutaneous device technology require accurate measurements and quantification of relationships between right ventricular outflow tract (RVOT) structures in children with and without congenital heart disease to determine device suitability. To date, no population study has described normal reference ranges of these measurements by computed tomography (CT). We aimed to establish normative values for four CT-derived measurements between RVOT structures from a heterogeneous population without heart disease and develop z scores useful for clinical practice. Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 at Children’s Hospital Colorado were included. Distance between the right ventricular (RV) apex to pulmonary valve (PV), PV to pulmonary trunk bifurcation, and bifurcation to the right and left pulmonary artery was measured. Previously validated models were used to normalize the measurements and calculate Z scores. Each measurement was plotted against BSA and Z scores distributions were used as reference lines. Three-hundred and sixty-four healthy patients with a mean age of 8.8 years (range 1–21), 58% male, and BSA of 1 m² (range 0.4–2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and Z-score boundaries for all measurements are presented.We report CT-derived normative data for four measurements between RVOT structures from a heterogeneous cohort of healthy children. Knowledge of this normative data will be useful in both determining device fit and customizing future devices to accommodate the diverse pediatric size range.

A 51‐year‐old patient with progressive right heart dysfunction was found to have a large calcified right atrial mass on echocardiography. As part of the work up for an intracardiac mass he had a cardiac computed tomogram which detailed a large coronary cameral fistula from the circumflex coronary artery to the right atrium associated with a spherical calcific pseudo‐aneurysmal sac. Transcatheter occlusion of the exit point into the atrium with a vascular plug was performed directly from a right atrial approach without the need for an arteriovenous wire loop. This case details a unique presentation of a coronary cameral fistula to an unusual position within the right atrium which facilitated the rare ability to occlude the fistula from a venous approach without creating an arteriovenous wire rail.

Background: Recent advances in available percutaneous device technology require accurate measurements and quantification of relationships between right ventricular outflow tract (RVOT) structures in children with and without congenital heart disease to determine device suitability. To date, no population study has described normal reference ranges of these measurements by computed tomography (CT). We aimed to establish normative values for four CT-derived measurements between RVOT structures from a heterogeneous population without heart disease and develop z-scores useful for clinical practice. Methods: Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 at Children’s Hospital Colorado were included. Distance between the right ventricular (RV) apex to pulmonary valve (PV), PV to pulmonary trunk bifurcation, and bifurcation to the right and left pulmonary artery were measured. Previously validated models were used to normalize the measurements and calculate Z-scores. Each measurement was plotted against BSA and Z-scores distributions were used as reference lines. Results: Three-hundred sixty-four healthy patients with a mean age of 8.8 years (range 1–21), 58% male, and BSA of 1 m ² (range 0.4–2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and Z-score boundaries for all measurements are presented. Conclusion: We report CT-derived normative data for four measurements between RVOT structures from a heterogenous cohort of healthy children. Knowledge of this normative data will be useful in both determining device fit and customising future devices to accommodate the diverse pediatric size range. Clinical Perspective: Recent advances in advanced percutaneous technology require accurate measurements and quantification of relationships between RVOT structures to determine patient selection and device suitability. The availability of a robust range of normal reference values can provide valuable information for current device selection and future development of customized devices for the RVOT tailored to accommodate the broad size, anatomic and physiologic heterogenicity seen in the pediatric population. We report CT-derived normative data for four measurements between cardio-pulmonary structures from a heterogenous cohort of healthy children and young adults. This data may be useful in planning surgical or catheter-guided interventions in the management of children with congenital heart disease.