Joseph J Vettukattil

Michigan Technological University | MTU · Center for Integrated Systems in Sensing, Imaging, and Communication (CISSIC)

Background: Pulmonary hypertension (PH) is a chronic progressive disease with mean pulmonary arterial pressure (MPAP) >25mmHg, progressing to right ventricular dysfunction, heart failure, and death. Treatment of PH in children remains challenging due to unpredictable outcomes on medical therapy and difficulty of obtaining hearts for transplantation...

Purpose Liver screening and longitudinal study of Fontan Associated Liver Diseases (FALD) is essential to identifying hepatomegaly and how hepatomegaly relates to various stages of liver fibrosis. In this study, we investigated longitudinal liver shape changes and liver stiffness in a cohort of patients with Fontan Associated Liver Disease. Method...

We report a case of a 25-year-old male with a heterotaxy-like constellation of congenital heart defects consisting of complete atrioventricular septal defect, transposition of the great arteries, subpulmonary stenosis, L-looped ventricles, hypoplastic right ventricle, and a distant aorta arising from the right ventricle. This case demonstrates how...

With the success of U-Net or its variants in automatic medical image segmentation, building a fully convolutional network (FCN) based on an encoder-decoder structure has become an effective end-to-end learning approach. However, the intrinsic property of FCNs is that as the encoder deepens, higher-level features are learned, and the receptive field...

Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the las...

Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the las...

The paper describes the first-in-human use of a dedicated, self-expandable covered stent system (VB stent) for closure of sinus venosus defects.

Background: Surgical repair is the gold standard for management of superior sinus venosus atrial septal defect (SVASD). Recently, transcatheter device closure is gaining momentum. Current devices and techniques have limitations like differential shortening, embolization, exclusion of many cases, potential of erosion and obstruction of the pulmonary...

Background Transesophageal echocardiogram (TEE) and balloon sizing have been used for transcatheter closure of secundum atrial septal defects (ASD). Balloon sizing may oversize the ASD especially those with redundant margins leading to bigger devices and increases the risk of complications. We aim to assess the feasibility of avoiding balloon sizin...

First in human implantation of a dedicated device to repair sinus venosus ASD

Coronary artery fistulas (CAFs) are abnormal connections of one or many coronary arteries to cardiac chambers or vessels of the systemic or pulmonary circulation. Currently, transcatheter closure method has proven its advantages for better outcome for most of the different types of CAFs, in comparison to surgical repair or ligation. The morphologic...

Paravalvular leak (PVL) is defined as regurgitant blood flow through a communication between an implanted heart valve and the surrounding tissue. Significant leaks following bioprosthetic or mechanical valves in the aortic or mitral position have been described. The reported incidence of PVLs is 10% at aortic position and 15% in mitral position. Th...

Paravalve leak (PVL) in the pulmonary position is a rare but significant complication of right ventricular outflow tract reconstruction with a valve. Often valved conduits are used which eliminates the risk of PVL. However, in instances where valve replacement is performed or when the procedure is complicated by infective process around the valve,...

Background: Up to 90% of adults with untreated atrial septal defect will be symptomatic by 4th decade, and 30-49% will develop heart failure. 8-10% of these patients have pulmonary arterial hypertension with a female predominance regardless of age. We aimed to demonstrate that fenestrated closure can be safely performed in patients with decompensa...

Background: Transcatheter repair of superior sinus venosus atrial septal defects (SVASD) using a covered stent has been gaining popularity as an alternative to surgery. However, the technique is new and in the absence of a dedicated device there has been multiple challenges not limited to stable anchoring in the Superior Vena Cava (SVC), avoiding o...

Introduction: Coronary artery fistula is a rare congenital cardiac anomaly connecting a coronary artery to a cardiac chamber. Right ventricle to coronary artery fistula is associated with pulmonary atresia with intact ventricular septum however, a left ventricle to coronary artery (LV-CA) fistula is extremely rare in the setting of aortic atresia a...

A patent foramen ovale (PFO) is a frequent incidental finding during echocardiography in otherwise healthy children. In most healthy children with a diagnosis of isolated incidental PFO, no further follow-up or intervention is necessary. In some children, PFO is associated with certain clinical syndromes such as cryptogenic stroke, decompression si...

Atrial Flow Regulator: A bridge to transplantation in severe pulmonary arterial hypertension Background Pulmonary artery hypertension (PAH) is a progressive disease, drastically impacting patients’ lives, culminating in right-sided hear failure (HF) and death. Despite advances in medical treatment, PAH is still not curable except for transplantati...

Concerns regarding the expanded Use of the One-Step Technique for simultaneous multiple stent loading for the placement of the Melody Transcatheter Pulmonary Valve

Use of AFR device to decompress the RA and improve cardiac output in patients with severe Pulmonary arterial hypertension as palliation or bridge to transplant. This series describes the patients who successfully underwent transplantation following AFR placement

In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA COVID-19 vaccine-associated myopericarditis (VAM) was noted. Only one adolescent with life-threatening complications was reported with no deaths at any of the participating institutions.

With the rate of cardiovascular diseases in the U.S increasing throughout the years, there is a need for developing more advanced treatment plans that can be tailored to specific patients and scenarios. The development of 3D printing is rapidly gaining acceptance into clinical cardiology. In this review, key technologies used in 3D printing are bri...

Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a non-stenotic SVC and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered CP (CCP) stent has the advantage of being avai...

Purpose of Review Atrioventricular septal defects (AVSD) represent a broad spectrum of congenital anomalies from simple to the most complex heart defects including some distinct types. Clinical presentation and timing of intervention differ by morphological subset and functional anatomy. Herein, we review morphological variations and characteristic...

A patent foramen ovale (PFO) is a frequent incidental finding during echocardiography in otherwise healthy children. In most healthy children with a diagnosis of isolated incidental PFO, no further follow up or intervention is necessary. In some children, PFO is associated with certain clinical syndromes such as cryptogenic stroke, decompression si...

A book for fellows and trainees in pediatrics as well as pediatricians.

Background: Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a non-stenotic SVC and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered CP (CCP) stent has the advantage...

Pulmonary arterial hypertension (PAH) is a severe and progressive disease. Treatment options include anti-PAH medications, continuous intravenous therapies, and diuretics. Lung transplant is required in many cases. Atrial septostomy is an under recognized option in symptomatic patients on maximal PAH therapy. However, creating a sustainable and res...

True 3D Viewer provides interactive 3D visualization improving diagnostics and evaluation. We present the case of a 23-year-old female to describe the utility of True 3D Viewer in making an accurate diagnosis of lung infarction enabling appropriate clinical management.

Fontan fenestration allows right-to-left shunting increasing cardiac output and oxygen delivery. Increased shunting occurs as cardiac function and ventricular end diastolic pressures improve, potentially decreasing oxygen saturation. Complete closure may result in impaired Fontan hemodynamics and low cardiac output, however, there are no dedicated...

Despite advances in percutaneous interventions, transcatheter Fontan completion remains experimental and performed only in select cases. Non‐surgical Fontan completion requires surgical preconditioning at an earlier stage of palliation. We describe transcatheter Fontan completion in a 15‐year‐old male with previously failed surgical Fontan palliati...

Although aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle palliation, there is a lack of understanding of pathophysiology, natural history, and outcomes with no universal guidelines for management and interventional practice. We conducted a study to assess the views held by interventional congenital cardiologis...

Background: Pulmonary interstitial glycogenosis (P.I.G.) is a children’s interstitial lung disease with abnormal accumulation of glycogen in the lung interstitium. The etiology and clinical significance of P.I.G. are unknown. However, association of P.I.G. with various pulmonary and cardiovascular conditions has been previously reported and may fur...

Modified Blalock–Taussig shunt thrombosis is a life-threatening event. We describe an extremely rare catheter-induced shunt thrombosis in an infant with complex CHD and its successful treatment utilising a single low dose of local recombinant tissue plasminogen activator in conjunction with balloon angioplasty.

Beginning with the discovery of X-rays to the development of three-dimensional (3D) imaging, improvements in acquisition, post-processing, and visualization have provided clinicians with detailed information for increasingly accurate medical diagnosis and clinical management. This paper highlights advances in imaging technologies for congenital hea...

Muscular pulmonary atresia with intact ventricular septum (PA/IVS) in neonates is traditionally managed by surgery. We describe hybrid approach to decompress the right ventricle (RV) and establish RV to pulmonary artery connection in a neonate avoiding cardiopulmonary bypass. A 21-gauge access needle was used to perforate the atretic pulmonary valv...

Extremely low birth weight neonates with complex congenital heart disease have increased mortality risk. Multi-organ dysfunction, pulmonary disease, fluctuating pulmonary vascular resistance, and complex cardiovascular anatomy create a challenge for effective management. We present the case of a 760-g neonate with dextro-transposition of the great...

Introduction: Aortic dissection is a life-threatening condition. It rarely occurs in children or adolescents. Early diagnosis and treatment are crucial. Case: A 16-year-old girl weighting 67 kg presented to the emergency department following an episode of dizziness and syncope. The past medical history was significant for ADHD, anxiety, and depress...

Sinus venosus atrial septal defect (SVASD) accounts for 5-10% of all ASDs. Partial anomalous pulmonary venous connection (PAPVC) and pulmonary hypertension (PH) in patients with SVASD increases the risk for surgical or transcatheter intervention. Closure is preferred over medical therapy. Transcatheter closure is challenging due to complex anatomy,...

Background: 3D printing, and interactive 3D visualization (I3DV) on True3DViewer (EchoPixel, Inc., Santa Clara, CA) for surgical planning in complex congenital heart disease (CHD) can influence decision-making, and alteration in surgical technique with positive impact on outcomes. 3D printed models and I3DV are also useful for education of patients...

Despite our growing experience in medical care of extremely preterm infants, there are serious gaps in the understanding of the adaptive physiology of the newborn. This is often misinterpreted and considered similar to that of adult physiology. The human psyche has been seriously influenced, both from an evolutionary and survival point of view, by...

The use of U.S. Food and Drug Administration (FDA) approved drugs for the treatment of an unapproved indication or in an unapproved age group, or at doses or route of administration not indicated on the label is known as off‐label use. Off‐label use may be beneficial in circumstances when the standard of care treatment has failed, and/or no other F...

Introduction: Neonates with muscular pulmonary atresia with intact ventricular septum (PA/IVS) are traditionally managed by surgical intervention. We describe hybrid approach for decompressing the right ventricle (RV) in a neonate with muscular PA/IVS, and severe tricuspid regurgitation (TR). Case Description: A 3-day-old male was born with muscula...

Background: Aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle physiology. The triggers for APC development and hemodynamic impact are not clearly understood. Consensus guidelines for timing and type of intervention are also lacking. Study Design: A survey was emailed to the PICS mailing list between February and...

Introduction: Transcatheter Fontan completion is a challenging procedure with no dedicated commercially available devices. We describe transcatheter Fontan completion using a custom-made Cheatham-Platinum (CP) StentTM (NuMED, Inc., Hopkinton, NY). Case Description: A 15-year-old male with history of double inlet left ventricle and L-transposition o...

Background: Approval of Class III medical devices by the U.S. Food and Drug Administration (FDA) can take from 3 to 7 years. However, patients with serious or life-threatening conditions have limited time to wait for device approval for necessary treatment or therapy. In these patients, expanded access to investigational devices may be the only tre...

Introduction: Transcatheter pulmonary valve replacement is a minimally invasive procedure. However, it is not risk-free as complications may occur in any step during transcatheter assessment and valve deployment. We describe a rare complication and its management. Case Description: A 9-year-old male with history of pulmonary atresia with ventricula...

Surgical management of complex congenital heart disease (CHD) is challenging. Three‐dimensional (3D) printing can improve multidisciplinary team decision‐making, patient and family understanding, and education of medical professionals. We describe 3D printing for surgical management of five patients with complex CHD. The anatomical details of the 3...

Left ventricular pseudoaneurysm (LV-PSA) is a rare complication following cardiac surgery, let alone in the pediatric population. Other known causes of LV-PSA are trauma, percutaneous cardiac intervention, and infections. This report describes the development of LV-PSA following surgical repair of ventricular septal defect (VSD) and coarctation of...

Neonates and infants with complex congenital heart disease (CHD) often require palliation followed by multiple surgeries for complete repair. Optimal outcomes following cardiac surgery is dependent on patient-specific anatomy, pulmonary artery (PA) pressures, ventricular pressures, and hemodynamic status. Prior to each surgical procedure these pati...

Introduction: 3D printing for surgical planning in complex congenital heart disease (CHD) can influence decision making with impact on outcomes and prognosis. The 3D-printed models are also useful for patient, family, and medical professional education. We analyzed our experience on the usefulness of 3D printing in decision making and personalized...

Unlike other intracardiac shunts, there is no known linear relationship between ostium secundum atrial septal defects (ASD) and development of pulmonary hypertension (PH). PH is observed in 8% to 10% of all ASD patients. Atrial septal defect–associated pulmonary hypertension (ASDAPH) is usually independent of the degree, duration of shunting, and d...

Background: 3D printing for surgical planning in complex congenital heart disease (CHD) can influence decision making with impact on outcomes and prognosis. The 3D-printed models are also useful for patient, family, and medical professional education. Objectives: To analyze our experience on the usefulness of 3D printing in decision making and pers...

Patients with single-ventricle physiology require staged palliation. Additional interventions may be required due to Fontan failure, formation of collaterals or pulmonary arteriovenous malformations (PAVMs). Transcatheter interventions are preferable in this setting to avoid the risks of redo-sternotomy, and cardiopulmonary bypass. We present our e...

Paravalvular leak (PVL) is a complication caused by development of gaps due to dehiscence between the annulus and implanted valve. Clinically significant PVL in bioprosthetic pulmonary valves are extremely rare. Currently, surgical intervention is the first line of treatment. However, surgery is associated with greater risk for morbidity and mortal...

The arterial switch operation (ASO) is the standard surgical technique for transposition of the great arteries. Although there have been significant improvements in long-term outcomes in patients undergoing the ASO when compared to the atrial switch procedure (Mustard or Senning), early and mid-term morbidity and mortality due to coronary complicat...

An infant with hypoplastic left heart syndrome (HLHS) presented with complete heart block and severe myocardial dysfunction requiring ECMO support due to complete left main coronary artery (LMCA) thrombosis. Current guidelines for managing coronary artery thrombosis in infants with single ventricle physiology are inadequate. We describe successful...

Primary ciliary dyskinesia (PCD) is a rare genetic condition characterized by respiratory tract infections, situs inversus or heterotaxy, and male infertility. Chronic respiratory infections begin in childhood and result in complications such as bronchiectasis. As hypoxemia is often attributed to bronchiectasis, other etiologies for desaturation in...

Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to eva...

Disease HISTORY AND PHYSICAL Paravalvular leak (PVL) is a complication due to suture dehiscence between the sewing ring and native tissue resulting in regurgitation around the replaced valve. The standard treatment for pulmonary PVL is surgical repair or valve replacement. However, surgery is associated with greater morbidity and mortality. Transca...

Background: Vascular rings describe a variety of vascular abnormalities resulting from the abnormal development of the aortic arch. Complications include the compression of the trachea, esophagus, or both. The overall incidence of vascular rings in the U.S. is approximately 1% of all congenital heart lesions. A tertiary referral center in the Midwe...

Introduction: Complete closure of atrial septal defects (ASD) in the setting of pulmonary hypertension (PH) can be detrimental to the patient due to the progressive nature of the disease. Fenestrated ASD closure is preferable in patients with PH as the fenestration allows a restricted interatrial shunt. The shunt can enhance systemic ventricular ou...

Introduction: Pulmonary vein stenosis is a rare condition with prevalence of about 1.7/100,000 children. Often pulmonary vein stenosis has syndromic association and can be difficult to manage due to multiple vein involvement. We present our experience of managing pulmonary vein stenosis in a patient with 3p deletion. Case description: A 19-month-ol...

Introduction: Patients with single-ventricle physiology require staged palliation. Additional interventions may be required due to Fontan failure, formation of collaterals or pulmonary arteriovenous malformations (PAVMs). Transcatheter interventions are preferable in this setting to avoid the risks of redo-sternotomy, and cardiopulmonary bypass. We...

Introduction: Transcatheter stenting is preferred over the surgical interventions for treating coarctation of aorta in adolescents and adults. However, percutaneous reconstruction of an interrupted or near-interrupted aortic arch is technically challenging. We describe our experience with transcatheter stenting in a patient with near-interrupted ao...

Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to eva...

Introduction: Pulmonary regurgitation (PR) is observed in up to 80% of patients following tetralogy of Fallot (TOF) repair. Free PR leads to progressive dilatation of the right ventricular outflow tract (RVOT), ventricular dysfunction, arrhythmias, and sudden death. Conventionally, these patients are treated by surgical or transcatheter pulmonary v...

Electrophysiological studies and interventions often require access to anatomic locations that are difficult to visualize with conventional imaging methods. Real-time three-dimensional echocardiography (RT3DTEE) has revolutionized interventional procedures by providing accurate visualization of cardiovascular structures. The 3D depth perception off...

Introduction: Cardiac catheterization studies are essential for thorough assessment of hemodynamics particularly in children with complex congenital heart disease (CHD) palliated with systemic to pulmonary artery (PA) shunts or with history of mechanical valve replacement. In these patients, crossing the shunt with an end-hole catheter or through t...