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ECMO 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 Permselect.com Polypropylene hollow fibers similar to dialysis (hydrophilic) Bridge to Recovery Bridge to Transplant Bridge to VAD 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 http://www.elsonet.org/index.php/resources /videos/viewvideo/22/elso-centers-ofexcellence/ecmo-centrum-karolinska.html Cardiac Septal Defects Shaun White Tetralogy of Fallot 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: Tissue types: Lining of CVS: fetal Vs adult conductive tissue, contractile tissue, (myocardial cells) connective tissue endothelial cells Atrial Septal Defect Secundum atrial septal defect Virtualmedicalcentral.com 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 Ventricular Septal Defect 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 intracardiac procedures BEATING-HEART REPAIR OF ATRIAL SEPTAL DEFECTS Courtesy Nikolay Vasilyev, MD, Children's Hospital Boston May suggest an increase in closures due to PC protocols rather than an increase in disease prevalence 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 diseaserelated complications Starflex VSD device NMT Medical Nickel cobalt chromium alloy struts with Dacron mesh Pericardial Patch http://www.youtube.com/watch?v=0NZLpW rJGgk http://www.youtube.com/watch?v=WfFLbW djMEw 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 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) http://www.youtube.com/watch?v=kPfHD2O9mA&feature=related Americanheart.org 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. 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) Ventricular Septal Defect Repair-Intracardiac surgical repair Cardioaccess.com Wellsley.edu Ductus Arteriosis in fetal circulation Patent Ductus Arteriosis Americanheart.org FDA Approved Devices Americanheart.org Fibrin Neoendothelialization Fibrin Thrombosis Cellular organization Foreign Body Giant Cells Lymphocyte Infiltration Implantation of biomaterial Thrombosis Endothelium Neoendothelialization FBGC Lymphocytes Infectious disease, the innate immune response, and fibrosis J. Clin. Invest. 117:3 doi:10.1172/JCI30595 [Go to this article.]