Currently, there are no clinically approved surgical glues that are nontoxic, bind strongly to tissue, and work well within wet and highly dynamic environments within the body. This is especially relevant to minimally invasive surgery that is increasingly performed to reduce postoperative complications, recovery times, and patient discomfort. We describe the engineering of a bioinspired elastic and biocompatible hydrophobic light-activated adhesive (HLAA) that achieves a strong level of adhesion to wet tissue and is not compromised by preexposure to blood. The HLAA provided an on-demand hemostatic seal, within seconds of light application, when applied to high-pressure large blood vessels and cardiac wall defects in pigs. HLAA-coated patches attached to the interventricular septum in a beating porcine heart and resisted supraphysiologic pressures by remaining attached for 24 hours, which is relevant to intracardiac interventions in humans. The HLAA could be used for many cardiovascular and surgical applications, with immediate application in repair of vascular defects and surgical hemostasis.

A Blood-Resistant Surgical Glue for Minimally Invasive Repair of Vessels and Heart Defects

The population of patients with congenital heart disease (CHD) is continuously increasing with more and more patients reaching adulthood. A significant portion of these young adults will suffer from arrhythmias due to the underlying congenital heart defect itself or as a sequela of interventional or surgical treatment. The medical community will encounter an increasing challenge as even most of the individuals with complex congenital heart defects nowadays become young adults. Within the past 20 years, management of patients with arrhythmias has gained remarkable progress including pharmacological treatment, catheter ablation, and device therapy. Catheter ablation in patients with CHD has paralleled the advances of this technology in pediatric and adult patients with structurally normal hearts. Growing experience and introduction of new techniques like the 3D mapping systems into clinical practice have been particularly beneficial for this growing population of patients with abnormal cardiac anatomy and physiology. Finally, device therapies allowing maintanence of chronotropic competence and AV conduction, improving haemodynamics by cardiac resynchronization, and preventing sudden death are increasingly used. For pharmacological therapy, ablation procedures, and device therapy decision making requires a deep understanding of the individual pathological anatomy and physiology as well as detailed knowledge on natural history and long-term prognosis of our patients. Composing expert opinions from cardiology and paediatric cardiology as well as from non-invasive and invasive electrophysiology this position paper was designed to state the art in management of young individuals with congenital heart defects and arrhythmias.

Arrhythmias in congenital heart disease : a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE

Ventricular septal defects are the commonest congenital cardiac malformations. They can exist in isolation, but are also found as integral components of other cardiac anomalies, such as tetralogy of Fallot, double outlet right ventricle, or common arterial trunk. As yet, there is no agreement on how best to classify such defects, nor even on the curved surface that is taken to represent the defect. Based on our previous pathological and clinical experiences, we have reviewed the history of classification of holes between the ventricles. We proposed that the defects are best defined as representing the area of deficient ventricular septation. This then permits the recognition of clinically significant variants according to the anatomic borders, and the way the curved surface representing the area of deficient septation opens into the morphologically right ventricle. Clinical manifestation depends on the size of the defect, and on the relationship between systemic and pulmonary vascular resistances. Symptoms include failure to thrive, along with the manifestations of the increase in flow of blood to the lungs. Diagnosis can be made by physical examination, but is confirmed by echocardiographic interrogation, which delineates the precise anatomy, and also provides the physiologic information required for optimal clinical decision-making. Cardiac catheterization offers additional information regarding hemodynamics, particularly if there is a concern regarding an increase in pulmonary vascular resistance. Hemodynamic assessment is rarely necessary to make decisions regarding management, although it can be helpful if assessing symptomatic adults with hemodynamically restrictive defects. In infants with defects producing large shunts, surgical closure is now recommended in most instances as soon as symptoms manifest. Only in rare cases is palliative banding of the pulmonary trunk now recommended. Closure with devices inserted on catheters is now the preferred approach for many patients with muscular defects, often using a hybrid procedure. Therapeutic closure should now be anticipated with virtually zero mortality, and with excellent anticipated long-term survival. Ventricular septal defects are best defined as representing the borders of the area of deficient ventricular septation. An approach on this basis permits recognition of the clinically significant phenotypic variants.

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Ventricular septal defect

Transcatheter Versus Surgical Closure of Perimembranous Ventricular Septal Defects in Children: A Randomized Controlled Trial

Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: Multicenter experience and mid-term follow-up

Complete heart block associated with device closure of perimembranous ventricular septal defects.

The safety and efficacy of a suture-mediated vascular closure device (Perclose, Abbott, Redwood City, CA) for hemostasis after percutaneous vascular access using >or=8-Fr sheath in the femoral vein after cardiac catheterization in children was assessed. Efficacy was determined by time to hemostasis and vessel integrity, using Doppler vascular ultrasound within 24 hours of the procedure. Forty children were randomized to treatment with either the closure device (n = 20, 10 males, weight 34.8 +/- 21 kg) or manual compression (n = 20, 10 males, weight 33.7 +/- 16 kg, P = 0.57 between groups for weight). Sheath sizes used were >or=8 French (8 Fr, n = 8; 9 Fr, n = 7; 10 Fr, n = 1; 11 Fr, n = 1; 12 Fr, n = 2; and 14 Fr, n = 1). Successful suture deployment was achieved in 14 of the 20 children. Mean time to hemostasis was 6.2 +/- 0.9 versus 14.9 +/- 1.1 minutes in controls (P = 0.003). Five of six unsuccessful deployments were in children with weights <20 kg. There were no differences in the occurrence of vascular complications (i.e., intraluminal thrombus) between the two groups as determined by ultrasound. A suture-mediated device appears safe and effective in achieving rapid vascular hemostasis even after the use of large sheath sizes in children.

Femoral Vein Hemostasis in Children Using a Suture‐Mediated Closure Device

Transcatheter management of native coarctation of the aorta in 3 children with Turner syndrome is reported. Two children, 12 and 17 years of age, underwent stent implantation and 1 child, 3 years old, underwent balloon angioplasty alone. In all children the procedures were successful, both hemodynamically and angiographically. Three- to 4-year follow-up after the procedures has revealed no signs of complications, including restenosis or aneurysm formation.

Transcatheter Repair of Native Coarctation in Children with Turner Syndrome: Three Case Reports and Literature Review

Background Cutting balloon angioplasty (CBA) has improved outcomes for resistant stenotic vascular lesions in adult coronary artery disease Application of this technique in coarctation of the aorta (CoA) in children has not been reported Objective We sought to review the safety, efficacy and outcomes of CBA in the setting of CoA Methods and Results Between February 2004 and October 2007, 8 children (4 males) underwent 10 procedures The median age was 55 months (range: 25 months to 5 years) and median weight 75 kg (range: 41―133 kg) Two children had native CoA CBA was employed due to a persistent waist after conventional balloon angioplasty (6 procedures) or as the primary dilatation (4 procedures) The cutting balloon diameter was a median 143% (range: 108―222%) of the diameter of the lesion After dilatation, all children underwent further conventional balloon angioplasty The CoA median diameter increased from 28 mm (range: 18―4 mm) to 4 mm (range: 29―67 mm; p = 00018), and the arm-to-leg blood systolic blood pressure gradient decreased from 385 mmHg (range: 2―70 mmHg) to 7 mmHg (0―30 mmHg; p < 00001) The median follow-up period was 46 months (range: 05―156 months), and 2 children required a second balloon dilatation No aneurysm formation was observed acutely, although 2 children each developed a femoral arteriovenous fistula or a pseudoaneurysm Conclusion This early experience suggests that CBA is acutely safe and can be effective in the management of recalcitrant coarctation lesions in the young

Akira Ozawa

Papers

Complete heart block associated with device closure of perimembranous ventricular septal defects.

Femoral Vein Hemostasis in Children Using a Suture‐Mediated Closure Device

Transcatheter Repair of Native Coarctation in Children with Turner Syndrome: Three Case Reports and Literature Review

Cutting balloon angioplasty for aortic coarctation.