\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Better outcomes depend on surgeons joining cardiologists.}



\author[1]{Leonardo Mulinari }%
\author[2]{Luciana Fonseca}%
\affil[1]{University of Miami Miller School of Medicine}%
\affil[2]{Children's Hospital of Pittsburgh of UPMC}%


\vspace{-1em}



  
  \date{May 28, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Closure of muscular ventricular septal defects remains a challenge for
cardiac surgeons and interventional cardiologists. Different techniques,
approaches, and devices are available to increase the success of these
procedures. Changwe et al, in this issue of the Journal, describe a
novel approach with the usage of a probe-guided system, with encouraging
results.%
\end{abstract}%



\sloppy


Title:

Better outcomes depend on surgeons joining cardiologists.

Authors

Leonardo Mulinari

(Corresponding Author)

University of Miami Miller School of Medicine, Surgery

1611 NW 12th Ave

East Tower Suite 3016A

Miami, FL, USA 33136-1015

l.mulinari@med.miami.edu

Luciana da Fonseca da Silva

Children's Hospital of Pittsburgh of UPMC, Cardiothoracic Surgery

4401 Penn Avenue

5th Floor Faculty Pavilion

Pittsburgh, PA, USA 15224

4125234078

dafonsecadasilval@upmc.edu

Data sharing is not applicable to this article as no new data were
created or analyzed in this study.

Funding: none

Conflict of interest: none

Hybrid approaches are being used for aortic stent implantation,
pulmonary valve implants, intraoperative stent implantation, and
perventricular ventricular septal defects closure.11Agrawal H,
Alkashkarib W, Kennyc D. Evolution of hybrid interventions for
congenital heart disease. Expert Review of Cardiovascular Therapy, 15:4,
257-266, DOI: 10.1080/14779072.2017.1307733

Closure of apical ventricular septal defects in infants is challenging
for surgeons and interventional cardiologists. Although a hybrid
approach has been used for some time, Changwe et al22Changwe GJ, Hongxin
L, Zhang HZ, et al. Percardiac closure of large apical ventricular
septal defects in infants: novel modifications and mid-term results.
\emph{Journal of Cardiac Surgery in press} describe a novel surgical
technique to close apical ventricular septal defects that uses a
probe-assisted delivery system. This is done through a chest incision
with the aid of transesophageal echocardiography.

Trans-catheter repair of apical interventricular septal defects (VSDs)
has been expanded to different defect types since its introduction into
clinical practice. Continuous improvements in occlusion devices and
sheaths have occurred. Vascular and bodyweight limitations, as well as
associated complications, led to the conception of percardiac device
closure techniques, especially for apical muscular VSDs.33Amin Z, Gu X,
Berry JM, Titus JL, Gidding SS and Rocchini AP. Periventricular closure
of ventricular septal defects without cardiopulmonary bypass. Ann Thorac
Surg 1999; 68:149-53.

This retrospective report by Changwe et al. reviews their clinical
experience since 2011 with 36 infants undergoing perventricular or
peratrial device closure of apical muscular VSDs. They divided the
population into three groups according to the access pathway applied.
They detail the advantages and limitations of the surgical technique in
each group, and report different locations and configurations of
muscular VSDs (Cylindrical, Tunnel, Cave-like, Multiple holed) that can
interfere with the surgical approach. The peratrial approach was more
aesthetical, less traumatic and painful, preserved RV wall intact, and
had a shorter length of hospital stay. However, the acute angle formed
by the peratrial route for VSD closure precludes its use in some
circumstances. Therefore, perventricular was the route was of choice for
complex VSD types (tortuous tunnel-shaped, cave-like, multiple) and the
anterior apical location. They showed that the perventricular pathway
was suitable for the occlusion of all types of apical VSDs.

There are limitations to this retrospective analysis when comparing the
three groups, mainly due to the morphological complexity of the defects.
The authors did not explain which criteria they used to choose the
access route in the different types and locations of the defects.
Increased success rate, without immediate complications, without the use
of Xray, small residual VSD percentage, with clinical improvement in
this challenging group of patients, reinforces the superiority of the
percardiac approach.

This approach provides an excellent alternative in the treatment of
patients with muscular VSDs. Long-term outcomes were excellent, and
morbidity associated with cardiopulmonary bypass and conventional
surgical repair was avoided. 44Kang SL, Tometzki A, Caputo M, Morgan G,
Parry A, Martin R. Longer-term outcome of perventricular device closure
of muscular ventricular septal defects in children. Catheter Cardiovasc
Interv. 2015 May;85(6):998-1005. doi: 10.1002/ccd.25821. Epub 2015 Feb
3. PMID: 25573696.

Patients with apical muscular VSD are challenging and the collaborative
approach between surgeons and interventional cardiologists seems to be
the best approach for better care.

\selectlanguage{english}
\FloatBarrier
\end{document}

