Cardiac Tamponade: Innovative Sternotomy Simulation Model for Training Pediatric Cardiac Intensive Care Team

Introduction: Cardiac tamponade occurring after cardiac surgery is rare but life threatening and requires simultaneous resuscitation and emergent sternotomy by the intensive care team. A simulated scenario using innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the face validity of this innovative mannequin, the confidence level and crisis resource management skills of the team during sternotomy to manage postoperative cardiac tamponade. Methods: The simulation case scenario was developed using innovative sternotomy mannequin for children’s hospital cardiac intensive care unit (CICU) teams. The case involved a 3-year old male, intubated, mechanically ventilated after surgical repair of CHD, progressing to cardiac arrest due to cardiac tamponade. We conducted a structured, video debriefing following each scenario. We conducted a formative learner assessment before and after each scenario and analyzed the data using student t-test. Results: Of the 72 CICU providers, a statistically significant proportion of providers (p \u3c 0.0001) showed improved confidence in assessing and managing cardiac arrest occurring following postoperative cardiac tamponade. All the providers scored ≥ 3 for impact of the scenario on practice, teamwork, communication, assessment skills, improvement in CPR and opening the chest and their confidence in attending similar clinical situation in future. Most (96–100%) scored ≥ 3 for perception on realism of mannequin, the scenario, re-opening the sternotomy and level of stress. Conclusions: Innovative adaptation of a high-fidelity mannequin for cardiac tamponade simulation can achieve a realistic and reproducible training model with a positive impact on multi-disciplinary team training

Advances in the Management of Congenital Malformations of the Aortic Valve

Congenital aortic valve disease is a life-long condition that can require multiple interventions. It is one of the most common causes of congenital heart defect, with bicuspid aortic valve present in at least 1−2% of the general population. Surgical management of congenital aortic valve disease consists of either valve repair or replacement. While aortic valve replacement using the Ross procedure can be considered the gold standard management in the pediatric population, advancements in aortic valve repair techniques have proved its usefulness as an initial management approach as it prevents prosthesis-related complications and patient-prostheses mismatch while the patient grows. Overall, all techniques have their benefits and limitations in terms of growth potential, durability of repair, freedom from reoperation and anticoagulation, infection risk, and mortality. Each patient will require an individualized judiciously selected management plan to minimize the number of interventions over their lifetime. The aim of this review is to discuss the merits and drawbacks of the major techniques currently used in both aortic valve repair and replacement

Utility of Three-Dimensional Printed Model in Biventricular Repair of Complex Congenital Cardiac Defects: Case Report and Review of Literature

Heterotaxy is a rare syndrome associated with cardiac complexity, anatomic variability and high morbidity and mortality. It is often challenging to visualize and provide an accurate diagnosis of the cardiac anatomy prior to surgery with the use of conventional imaging techniques. We report a unique case demonstrating how the use of three-dimensional (3D) cardiac printed model allowed us to better understand the anatomical complexity and plan a tailored surgical approach for successful biventricular repair in a patient with heterotaxy syndrome