Postinfarction ventricular septal rupture: Transcatheter intervention or surgical repair?

Postinfarction ventricular septal rupture is an infrequent but potentially fatal complication of acute myocardial infarction. The 30-day mortality rate with the transcatheter approach when performed in the acute phase (<2 weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within 3 weeks). There is no correlation between defect size and mortality. New York Heart Association class IV and time to ventricular septal defect closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.

Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians

OBJECTIVE

Although simulation-based education is now commonly utilized in medicine, its use in the instruction of congenital heart disease remains limited. The objective of this study is to evaluate whether heart models created with three-dimensional printing technology can be effectively incorporated into a simulation-based congenital heart disease and critical care training curriculum for pediatric resident physicians.

DESIGN

Utilizing heart models created with a three-dimensional printer, pediatric residents participated in a 60-minute simulation seminar with three consecutive components: (1) didactic instruction on ventricular septal defect anatomy; (2) didactic/simulation-based instruction on echocardiographic imaging of ventricular septal defects and anatomical teaching/operative simulation of ventricular septal defect repair; (3) simulation-based instruction on postoperative critical care management of ventricular septal defects.

SETTING

Academic, free-standing, children's hospital with quaternary care referrals.

PARTICIPANTS

Twenty-three pediatric resident physicians.

OUTCOME MEASURES

Subjective, Likert-type questionnaires assessing knowledge acquisition, knowledge reporting, and structural conceptualization of ventricular septal defects.

RESULTS

Three-dimensional printing technology was successfully utilized to create heart models of five common ventricular septal defect subtypes. After using these models in a simulation-based curriculum, pediatric residents were found to have improvement in the areas of knowledge acquisition (P = .0082), knowledge reporting (P = .01), and structural conceptualization (P < .0001) of ventricular septal defects, as well as improvement in the ability to describe and manage postoperative complications in ventricular septal defect patients in the critical care setting.

CONCLUSIONS

The utilization of three-dimensional printing in a simulation-based congenital heart disease and critical care training curriculum is feasible and improves pediatric resident physicians' understanding of a common congenital heart abnormality.