1. Artificial support for the heart and lungs for prolonged periods of time
ECMO

2. ECMO first developed in 1972 with initially marginal results.
The first neonatal ECMO case – 1976; clinical trials in 1978 halted due to high efficacy and need for therapy
Primarily used for neonates and pediatrics but recently being used more often for adult ARDS patients

5. Permselect.com

6. Polypropylene hollow fibers similar to dialysis (hydrophilic)

7. Bridge to Recovery
Bridge to Transplant
Bridge to VAD

10. Complications Thrombosis and emboli formation
Bleeding and dissection of vessels
Seizures due to hemorrhage
Stroke
Pneumothorax
Metabolic complications due to acid-base balance (CO2 concentrations)
Sensory-neural complications
Developmental delays

11. http://www. elsonet. org/index

12. Cardiac Septal Defects
Shaun White
Tetralogy of Fallot

13. The heart pumps blood to the pulmonary and systemic circulations
in order to deliver oxygen and nutrients and to remove carbon dioxide
and metabolic waste products from tissues
Fetal circulation
Adult circulation
Key Points:
Flow of blood: fetal Vs adult
Tissue types: conductive tissue, contractile tissue, (myocardial cells) connective tissue
Lining of CVS: endothelial cells

14. Atrial Septal Defect
Secundum atrial septal defect This is the most common atrial septal defect, affecting 80 percent of people with this defect.
It is caused when a part of the atrial septum fails to close completely while the heart is developing.
This causes an opening to develop between the atria.
Asymptomatic or symptomatic including shortness of breath, increased susceptibility to pneumonia
and bronchitis, heart murmur, progressive vascular disease in the lung
Virtualmedicalcentral.com

15. Ventricular Septal Defect

16. 10% of congenital cardiac defects
1952-First intra-cardiac surgical repair of ASD
1976-First transcatheter (PC) closure
Right side heart dilation, arrhythmias, emboli are all indications for repair
Closure of ASDs can be completed invasively using intra-cardiac procedures or by catheterization
Surgeon
DaVince robot
VSD are usually closed using intra-cardiac procedures
BEATING-HEART REPAIR OF ATRIAL SEPTAL DEFECTS
Courtesy Nikolay Vasilyev, MD, Children's Hospital Boston

17. May suggest an increase in closures due to
PC protocols rather than an increase in
disease prevalence

18. ASDs and VSDs can be repaired using a Dacron patch, pericardial patch or a biomaterial-based catheter device (see later slide)
Most repairs are completed in young children in order to prevent complications such as arterial damage, pulmonary disease and congestive heart failure later on in life
Older patients can have ASD repair and most of these are completed successfully and actually may be unnecessary since these patients have lived normal lives with no disease-related complications
Starflex VSD device
NMT Medical
Nickel cobalt chromium alloy struts with
Dacron mesh

19. Pericardial Patch http://www.youtube.com/watch?v=0NZLpWrJGgk
Atrioventricular septal defect with tetralogy of Fallot in patient with Down's syndrome
Maria Fernanda Ferrari Balthazar Jacob; Carlos Henrique De Marchi; Ulisses Alexandre Croti; Domingo Marcolino Braile
Pediatric Cardiovascular Surgery Service of São José do Rio Preto - Hospital de Base - Faculdade de Medicina de São José do Rio Preto

20. Atrial Septal Defect Repair-Catheter Closure
AMPLATZER® Septal Occluder for heart defect repair utilizes the shape memory of Nitinol, a wire made from an alloy of nickel and titanium. Each Occluder is made of a Nitinol wire mesh that is shaped into two flat discs and a middle, or "waist" to fit the defect size, with polyester fabric inserts designed to help close the hole and provide a foundation for growth of tissue over the occluder after placement. (ADA Medical)
Americanheart.org

21. Nitinol
Nitinol which is a material used for the supportive strut is an alloy of nickel and titanium
Nitinol’s mechanical properties include hardness, impact toughness, fatigue strength, and machinability
In addition, Nitinol has shape memory which is a material’s ability return to a particular shape depending upon thermal changes
Strength
Yield strength is the lowest stress that gives permanent deformation in a material.
Compressive strength is a limit state of compressive stress that leads to compressive failure in the manner of ductile failure or in the manner of brittle failure
Tensile strength or ultimate tensile strength is a limit state of tensile stress that leads to tensile failure in the manner of ductile failure (yield as the first stage of failure, some hardening in the second stage and break after a possible "neck" formation) or in the manner of brittle failure (sudden breaking in two or more pieces with a low stress state).
Fatigue strength is a measure of the strength of a material or a component under cyclic loading
Impact strength it is the capability of the material in withstanding by the suddenly applied loads in terms of energy.

22. Dacron: poly(ethylene terephthalate)
Thermoplastic polymer that becomes liquid when heated and solid when cooled
Thermoplastics can be molded or extruded into fibers
Generally biocompatible inducing minimal inflammatory reactions with subsequent fibrotic reactions
Woven
(vascular grafts)
Knitted (ASD patch)

23. Ventricular Septal Defect Repair-Intracardiac surgical repair
Cardioaccess.com

24. Ductus Arteriosis in fetal circulation
Wellsley.edu
Ductus Arteriosis in fetal
circulation

25. Patent Ductus Arteriosis
Americanheart.org

26. FDA Approved Devices
Americanheart.org

27. Biocompatibility of Closure Devices
Fibrin
Neoendothelialization

28. Biocompatibility of Closure Devices
Fibrin
Thrombosis
Cellular organization

29. Biocompatibility of Closure Devices
Foreign Body Giant Cells
Lymphocyte Infiltration

30. Implantation of biomaterial
Thrombosis
Endothelium
Neoendothelialization
FBGC
Lymphocytes
Infectious disease, the innate immune response, and fibrosis J. Clin. Invest. 117:3 doi: /JCI30595 [Go to this article.]