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Ponzoni M, Alamri R, Peel B, Haller C, Coles J, Vanderlaan RD, Honjo O, Barron DJ, Yoo SJ. Longitudinal Evaluation of Congenital Cardiovascular Surgical Performance and Skills Retention Using Silicone-Molded Heart Models. World J Pediatr Congenit Heart Surg 2024; 15:332-339. [PMID: 38646823 PMCID: PMC11100265 DOI: 10.1177/21501351241237785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 04/23/2024]
Abstract
Objective: Hands-on surgical training (HOST) for congenital heart surgery (CHS), utilizing silicone-molded models created from 3D-printing of patients' imaging data, was shown to improve surgical skills. However, the impact of repetition and frequency of repetition in retaining skills has not been previously investigated. We aimed to longitudinally evaluate the outcome for HOST on two example procedures of different technical difficulties with repeated attempts over a 15-week period. Methods: Five CHS trainees were prospectively recruited. Repair of coarctation of the aorta (CoA) and arterial switch operation (ASO) were selected as example procedures of relatively low and high technical difficulty. Procedural time and technical performance (using procedure-specific assessment tools by the participant, a peer-reviewer, and the proctor) were measured. Results: Coarctation repair performance scores improved after the first repetition but remained unchanged at the follow-up session. Likewise, CoA procedural time showed an early reduction but then remained stable (mean [standard deviation]: 29[14] vs 25[15] vs 23[9] min at 0, 1, and 4 weeks). Conversely, ASO performance scores improved during the first repetitions, but decreased after a longer time delay (>9 weeks). Arterial switch operation procedural time showed modest improvements across simulations but significantly reduced from the first to the last attempt: 119[20] versus 106[28] min at 0 and 15 weeks, P = .049. Conclusions: Complex procedures require multiple HOST repetitions, without excessive time delay to maintain long-term skills improvement. Conversely, a single session may be planned for simple procedures to achieve satisfactory medium-term results. Importantly, a consistent reduction in procedural times was recorded, supporting increased surgical efficiency.
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Affiliation(s)
- Matteo Ponzoni
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rawan Alamri
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brandon Peel
- Center for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Coles
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel D. Vanderlaan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J. Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Center for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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Zhang X, Yi K, Xu JG, Wang WX, Liu CF, He XL, Wang FN, Zhou GL, You T. Application of three-dimensional printing in cardiovascular diseases: a bibliometric analysis. Int J Surg 2024; 110:1068-1078. [PMID: 37924501 PMCID: PMC10871659 DOI: 10.1097/js9.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
AIM This paper aimed to explore the application of three-dimensional (3D) printing in cardiovascular diseases, to reach an insight in this field and prospect the future trend. METHODS The articles were selected from the Web of Science Core Collection database. Excel 2019, VOSviewer 1.6.16, and CiteSpace 6.1.R6 were used to analyze the information. RESULTS A total of 467 papers of 3D printing in cardiovascular diseases were identified, and the first included literature appeared in 2000. A total of 692 institutions from 52 countries participated in the relevant research, while the United States of America contributed to 160 articles and were in a leading position. The most productive institution was Curtin University , and Zhonghua Sun who has posted the most articles ( n =8) was also from there. The Frontiers in Cardiovascular Medicine published most papers ( n =25). The Journal of Thoracic and Cardiovascular Surgery coveted the most citations ( n =520). Related topics of frontiers will still focus on congenital heart disease, valvular heart disease, and left atrial appendage closure. CONCLUSIONS The authors summarized the publication information of the application of 3D printing in cardiovascular diseases related literature from 2000 to 2023, including country and institution of origin, authors, and publication journal. This study can reflect the current hotspots and novel directions for the application of 3D printing in cardiovascular diseases.
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Affiliation(s)
- Xin Zhang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Kang Yi
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
| | - Jian-Guo Xu
- Evidence-Based Medicine Center, School of BasicMedical Sciences, Lanzhou University
| | - Wen-Xin Wang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Cheng-Fei Liu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- The First Clinical Medical College of Lanzhou University, Lanzhou, People's Republic of China
| | - Xiao-Long He
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Fan-Ning Wang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
| | - Guo-Lei Zhou
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
| | - Tao You
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
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Barron DJ, Hussein N, Yoo SJ. Training on Congenital 3D Cardiac Models - Will Models Improve Surgical Performance? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:9-17. [PMID: 36842804 DOI: 10.1053/j.pcsu.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Technical skill development in congenital heart surgery (CHS) is challenging due to numerous factors which potentially limit the hands-on operative exposure in surgical training. These challenges have stimulated the growth of simulation-based training through the development of 3D-printed models, providing hands-on surgical training (HOST). From its inception in 2015, the models used in the HOST program have constantly improved, and now include valvar/subvalvar apparatus and better materials that mimic real tissue. Evidence shows that deliberate, regular simulation practice can improve a surgeon's technical skills across the spectrum of CHS. Furthermore, surgical trainees who undergo simulation training are able to translate this improved performance into the operative environment with improved patient outcomes. Despite evidence to support the incorporation of simulation methods into congenital training, its widespread adoption into training curricula remains low. This is due to numerous factors including funding, lack of dedicated time or proctorship and access to models-all of which can be overcome with the newer generation of models and committed trainers. Training programs should consider incorporating simulation-methods as a routine component of congenital training programs.
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Affiliation(s)
- David J Barron
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, England, UK
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Cattapan C, Guariento A, Bifulco O, Caraffa R, Bertelli F, Reffo E, Padalino M, Di Salvo G, Vida V. Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return. J Clin Med 2023; 12:jcm12020472. [PMID: 36675399 PMCID: PMC9863474 DOI: 10.3390/jcm12020472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Objectives: The surgical technique for right partial anomalous pulmonary venous return (PAPVR) depends on the location of the anomalous pulmonary veins (PVs). With this in mind, we sought to evaluate the impact of 3D heart segmentation and reconstruction on preoperative surgical planning. Methods: A retrospective study was conducted on all patients who underwent PAPVR repair at our institution between January 2018 and October 2021; three-dimensional segmentations and reconstructions of all the heart anatomies were performed. A score (the PAPVR score) was established and calculated using two anatomical parameters (the distance between the most cranial anomalous PV and the superior rim of the sinus venosus defect/the sum of the latter and the distance between the PV and the azygos vein) to predict the type of correction. Results: A total of 30 patients were included in the study. The PAPVR score was found to be a good predictor of the type of surgery performed. A value > 0.68 was significantly associated with a Warden procedure (p < 0.001) versus single/double patch repair. Conclusions: Three-dimensional heart segmentations and reconstructions improve the quality of surgical planning in the case of PAPVR and allow for the introduction of a score that may facilitate surgical decisions on the type of repair required.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Olimpia Bifulco
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Raphael Caraffa
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Elena Reffo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-049-8212427
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Hussein N, Van den Eynde J, Callahan C, Guariento A, Gollmann-Tepeköylü C, Elbatarny M, Loubani M. The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2022; 35:6651070. [PMID: 35900153 PMCID: PMC9403301 DOI: 10.1093/icvts/ivac194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula. METHODS Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity. CONCLUSIONS Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons.
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Affiliation(s)
- Nabil Hussein
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | | | - Connor Callahan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Malak Elbatarny
- Department of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Loubani
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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Hopfner C, Jakob A, Tengler A, Grab M, Thierfelder N, Brunner B, Thierij A, Haas NA. Design and 3D printing of variant pediatric heart models for training based on a single patient scan. 3D Print Med 2021; 7:25. [PMID: 34463879 PMCID: PMC8406574 DOI: 10.1186/s41205-021-00116-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background 3D printed models of pediatric hearts with congenital heart disease have been proven helpful in simulation training of diagnostic and interventional catheterization. However, anatomically accurate 3D printed models are traditionally based on real scans of clinical patients requiring specific imaging techniques, i.e., CT or MRI. In small children both imaging technologies are rare as minimization of radiation and sedation is key. 3D sonography does not (yet) allow adequate imaging of the entire heart for 3D printing. Therefore, an alternative solution to create variant 3D printed heart models for teaching and hands-on training has been established. Methods In this study different methods utilizing image processing and computer aided design software have been established to overcome this shortage and to allow unlimited variations of 3D heart models based on single patient scans. Patient-specific models based on a CT or MRI image stack were digitally modified to alter the original shape and structure of the heart. Thereby, 3D hearts showing various pathologies were created. Training models were adapted to training level and aims of hands-on workshops, particularly for interventional cardiology. Results By changing the shape and structure of the original anatomy, various training models were created of which four examples are presented in this paper: 1. Design of perimembranous and muscular ventricular septal defect on a heart model with patent ductus arteriosus, 2. Series of heart models with atrial septal defect showing the long-term hemodynamic effect of the congenital heart defect on the right atrial and ventricular wall, 3. Implementation of simplified heart valves and addition of the myocardium to a right heart model with pulmonary valve stenosis, 4. Integration of a constructed 3D model of the aortic valve into a pulsatile left heart model with coarctation of the aorta. All presented models have been successfully utilized and evaluated in teaching or hands-on training courses. Conclusions It has been demonstrated that non-patient-specific anatomical variants can be created by modifying existing patient-specific 3D heart models. This way, a range of pathologies can be modeled based on a single CT or MRI dataset. Benefits of designed 3D models for education and training purposes have been successfully applied in pediatric cardiology but can potentially be transferred to simulation training in other medical fields as well.
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Affiliation(s)
- Carina Hopfner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Andre Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Grab
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Barbara Brunner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alisa Thierij
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
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Yoo SJ, Hussein N, Peel B, Coles J, van Arsdell GS, Honjo O, Haller C, Lam CZ, Seed M, Barron D. 3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation. Front Pediatr 2021; 9:621672. [PMID: 33614554 PMCID: PMC7892770 DOI: 10.3389/fped.2021.621672] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/06/2021] [Indexed: 12/05/2022] Open
Abstract
3D printing allows the most realistic perception of the surgical anatomy of congenital heart diseases without the requirement of physical devices such as a computer screen or virtual headset. It is useful for surgical decision making and simulation, hands-on surgical training (HOST) and cardiovascular morphology teaching. 3D-printed models allow easy understanding of surgical morphology and preoperative surgical simulation. The most common indications for its clinical use include complex forms of double outlet right ventricle and transposition of the great arteries, anomalous systemic and pulmonary venous connections, and heterotaxy. Its utility in congenital heart surgery is indisputable, although it is hard to "scientifically" prove the impact of its use in surgery because of many confounding factors that contribute to the surgical outcome. 3D-printed models are valuable resources for morphology teaching. Educational models can be produced for almost all different variations of congenital heart diseases, and replicated in any number. HOST using 3D-printed models enables efficient education of surgeons in-training. Implementation of the HOST courses in congenital heart surgical training programs is not an option but an absolute necessity. In conclusion, 3D printing is entering the stage of maturation in its use for congenital heart surgery. It is now time for imagers and surgeons to find how to effectively utilize 3D printing and how to improve the quality of the products for improved patient outcomes and impact of education and training.
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Affiliation(s)
- Shi Joon Yoo
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - Nabil Hussein
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Brandon Peel
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - John Coles
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Glen S. van Arsdell
- Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, United States
| | - Osami Honjo
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
| | - David Barron
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
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