What can you tell us about your facility/practice at the RUSH Center for Congenital and Structural Heart Disease?

The RUSH Center for Congenital and Structural Heart Disease (Chicago, IL) was created to amalgamate pediatric and adult congenital and structural heart diagnoses and interventions under one umbrella. Ziyad Hijazi, MD, started the center, and I joined as Director of Cardiac Catheterization and the Hybrid Suite. Our third partner is Clifford Kavinsky, MD, PhD. We built a state-of-the-art hybrid laboratory in June 2008. We do all cardiac catheterization (diagnostic and interventional) procedures, in addition to hybrid procedures, with our surgeons in the hybrid suite. We provide cutting-edge interventions to patients of all ages. We have three dedicated nurses and four technicians who help us run the suite smoothly.

What are you excited about/looking forward to in the evolution of percutaneous valve replacement?
Percutaneous valve replacement is the "buzz word" nowadays. This is an exciting time to be an interventionist. Aortic valve replacement and, to some extent, pulmonary valve replacement are already established techniques. However, there is definitely room for valve development in the mitral and the tricuspid arena. For me, the most exciting part of this development is the decrease in postprocedure morbidity rates in patients who have undergone this procedure. Some of these patients are in extremis before the intervention, and it is amazing to see the improvement in their quality of life after the procedure, which happens in a much shorter time when compared to surgical morbidity.

What has been your experience with animal research?
I became interested in animal research when I was a fellow in training. I had the good fortune to work with Kurt Amplatz, MD, the founder of AGA Medical Corporation (Plymouth, MN) and inventor of several interventional products. I did extensive animal research with him and was able to help in developing the Amplatzer muscular ventricular septal defect (VSD) and membranous VSD occluder. It was during this research that I was able to introduce and advance the perventricular technique (intraoperative, noncardiopulmonary bypass technique) for VSD closures. While working with another company, I performed the first perventricular (also referred to as transventricular) pulmonary valve procedure in a sheep model. As you know, this technique was later adopted by other interventionists to place percutaneous aortic valves through the left ventricle apex. The RUSH Center has an excellent animal laboratory, which has been approved by Good Laboratory Practices. We hold several training courses in this laboratory for a number of companies.

Do you think robotic assistance will gain popularity as a helpful tool in the closure of perimembranous ventricular septal defects?
I think you are asking this question because in one of my publications, we used robotic assistance for perventricular closure of perimembranous VSD. I believe that if the robotic ports can be miniaturized, robotic closure will progress without any question. A majority of the patients who require closure of perimembranous VSD are young children with a weight range of 3 to 10 kg. However, the currently available ports are too big for such small patients. I know that one company had introduced 5-mm ports a few years ago, but for pediatric patients, we still need ports that are smaller than 5 mm. I believe that this is very possible. In the majority of such circumstances, supply and demand governs the research.

What is your biggest concern with the present treatments for structural heart disease?
Currently, there are more adults with repaired congenital heart defects than children with congenital heart disease. As these patients transition into adulthood, it becomes increasingly difficult for the pediatric interventionist to continue to treat them because they may not be trained to take care of such patients. My biggest concern is lack of sufficiently trained personnel. Several guidelines are being established that outline minimum training requirements for such physicians. There was a recent article in Circulation that addressed the necessary training criteria. Taking care of these patients is a huge commitment, but it's definitely something we can achieve.

Are you participating in any trials at the moment?
Yes, my colleagues and I are involved in several trials. We are part of the EVEREST II REALISM trial for percutaneous mitral valve repair (Evalve, Inc., Menlo Park, CA), the Gore REDUCE study for stroke patients (W. L. Gore & Associates, Flagstaff, AZ), the Edwards Sapien percutaneous pulmonary valve trial (COMPASSION [Congenital Multicenter Trial of Pulmonic Valve Regurgitation Studying the Sapien Interventional THV]) (Edwards Lifesciences, Irvine, CA), and the AGA Medical postmarket surveillance trial for atrial septal defect (ASD) (PMSASD II) and VSD (Closure of Muscular VSD with the Amplatzer Muscular VSD Occluder Postapproval Study). We have also been invited to be part of Amplatzer cardiac plug (ACP) trial for left atrial appendage closure, among others.

I believe that the COMPASSION trial will help patients with postoperative pulmonary valve stenosis and regurgitation, the majority of whom are currently subjected to surgery. The strength of the stent in the Edwards valve has already been tested in the aortic position, and therefore, when it is placed in the tight right ventricular outflow tract conduits, it can resist compression from the chest wall. These patients typically require several valve replacements under cardiopulmonary bypass. A minimally invasive percutaneous approach will be a huge welcome once the trial is complete.

The ASD and VSD trials for AGA Medical are very important. These are to follow patients after the procedure for known and unknown potential complications. This definitely will give us insight as to the optimal management of these patients.

The Amplatzer ACP trial is geared toward left atrial appendage occlusion. This device will help in closure of the left atrial appendage in patients with atrial arrhythmias who require warfarin therapy. It has a very simple design, and the procedure is relatively simple with this device, as well.