To evaluate the impact of 3D printed models (3D models) on surgical planning in complex congenital heart disease (CHD). A prospective case-crossover study involving 10 international centres and 40 patients with complex CHD (median age 3 years, range 1 month–34 years) was conducted. Magnetic resonance imaging and computed tomography were used to acquire and segment the 3D cardiovascular anatomy. Models were fabricated by fused deposition modelling of polyurethane filament, and dimensions were compared with medical images. Decisions after the evaluation of routine clinical images were compared with those after inspection of the 3D model and intraoperative findings. Subjective satisfaction questionnaire was provided. 3D models accurately replicate anatomy with a mean bias of −0.27 ± 0.73 mm. Ninety-six percent of the surgeons agree or strongly agree that 3D models provided better understanding of CHD morphology and improved surgical planning. 3D models changed the surgical decision in 19 of the 40 cases. Consideration of a 3D model refined the planned biventricular repair, achieving an improved surgical correction in 8 cases. In 4 cases initially considered for conservative management or univentricular palliation, inspection of the 3D model enabled successful biventricular repair. 3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach.

During traditional surgery, the surgeons’ hands are in direct contact with organs, and surgeons rely on the sense of touch to perform surgery. In teleoperated robotic systems, all physical connections between the surgeon and both the robot and patient, are absent. The surgeon must estimate the force exerted on organs, based only on visual deformation of tissues he is pulling, pushing, gripping, or suturing. It is hard to imagine how to operate with no haptic sensations, and it is surprising that commercially available robots didn’t include until now any Haptic Feedback, despite reports about tissue injury, and inability to perform complex manipulation. The sense of touch must be created by stimuli sensed by the surgeon. Haptic sensors are required to collect and send haptic information, and display them on the operator’s side, creating telepresence, known as transparency. Multiple ways have been developed to improve transparency through force feedback and tactile feedback. However, this interferes with the stability of the closed-loop controlling interactions between master, robot and remote environment. Cutaneous feedback is more stable and less transparent; force feedback is more transparent and less stable. Thus, multimodal platforms of haptic feedback would try to find the best trade-off between both modalities.

Abstract: Heyde's syndrome is the association between calcific aortic stenosis and gastrointestinal bleeding due to angiodysplasia. Alterations in von Willebrand factor due to turbulence across the diseased aortic valve have been incriminated in the pathophysiology of this syndrome. Replacement of the aortic valve has been reported to stop the bleeding, but this is debatable. Along with a review of the relevant medical literature, we hereby report a 68 year old patient with aortic stenosis and severe recurrent gastrointestinal bleeding that completely subsided following aortic valve replacement.

Background: GATA transcription factors are evolutionary conserved zinc finger proteins with multiple roles in cell differentiation/proliferation and organogenesis. GATA5 is only transiently expressed in the embryonic heart, and the inactivation of both Gata5 alleles results in a partially penetrant bicuspid aortic valve (BAV) phenotype in mice. We hypothesized that only biallelic mutations in GATA5 could be disease causing.Methods: A total of 185 patients with different forms of congenital heart disease (CHD) were screened along 150 healthy individuals for GATA4, 5, and 6. All patients' phenotypes were diagnosed with echocardiography.Results: Sequencing results revealed eight missense variants (three of which are novel) in cases with various conotruncal and septal defects. Out of these, two were inherited in recessive forms: the p.T67P variant, which was found both in patients and in healthy individuals, and the previously described p.Y142H variant which was only found in a patient with a double outlet right ventricle (DORV). We characterized the p.Y142H variant and showed that it significantly reduced the transcriptional activity of the protein over cardiac promoters by 30–40%.Conclusion: Our results do prove that p.Y142H is associated with DORV and suggests including GATA5 as a potential gene to be screened in patients with this phenotype.

We report the successful management of a circumflex coronary artery aneurysm with fistula to the coronary sinus. Our strategy aimed at closing the fistula and grafting the obtuse marginal artery. The calcified aneurysm was left intact, and showed secondary thrombus formation on the postoperative angiogram.