Successful bridge to transplantation for pediatric lupus cardiomyopathy

both left and right VAD applications, and cannula length and angle were determined for each application. Fitting was determined for pump placement in two configurations: (1) on the diaphragmatic surface of the heart; and (2) along the lateral ventricular wall. Intra-operative fitting studies were performed in 6 pediatric patients with a BSA range of 0.23 to 0.63 m 2 . Better fitting of the current pump prototype, for use as a left or right VAD, was possible when the model was placed on the diaphragm anterior to the ventricles. Intracorporeal implantation of the current pump prototype in the 3-month-old infants was hindered by the lack of retrosternal space for placement of the outflow graft with likely coronary and lung compression. Full intracorporeal implantation in Patient 4 (11 months of age, BSA 0.63 m 2 ) also seemed to create the potential for lung compression. Intracorporeal implantation appeared to be feasible in both 3-year-old patients (Figure 2). We have previously described the usefulness of 3-dimensional on-screen models in providing device-fitting information that could help overcome some limitations associated with animal and cadaver studies. 3 In the present study, intra-operative fitting provided additional in vivo information that augments data derived from other sources. Unlike imaging or cadaver studies, this in vivo approach allows direct visualization of possible positional interferences due to device placement during normal cardiac motion with full lung inflation. It also provides information regarding the lower limits of patient size for which an implantable system could be considered; for the present prototype, intracorporeal implantation in toddlers appears to be feasible. Based on these results, a next generation version of the PediPump that is considerably smaller is currently being developed and will undergo similar in vivo fitting studies to determine whether it can be adapted for use in infants.