Objectives To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septal defect(VSD) closure simulation translates to better patient outcomes. Methods Seven trainees were divided into two groups. Experienced-fellows group included four senior trainees who had performed>five VSD closures. Residents group consisted of three residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a four-week simulation requiring each participant to complete two VSD closures on 3D-printed models per week. One-month later all trainees returned for a posttest operation in real patients. All performances were recorded, blinded and scored independently by two cardiac surgeons using the validated Hands-On Surgical Training–Congenital Heart Surgery(HOST-CHS). Predefined surgical outcomes were analyzed. Results The median HOST-CHS score increased significantly from week one to four [50(39,58) vs.73(65,74), p < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition[HOST-CHS score 72.5(71, 74)vs.54(51, 60), p < 0.001], with better patients outcomes including shorter total cross-clamp time[pretest: 86(70,99) vs.posttest: 60(53, 64) min, p = 0.006], and reduced incidence of major patch leak requiring multiple pump runs[pretest: 4/11vs.posttest: 0/9, p = 0.043]. After simulation, the technical performance and surgical outcomes of residents were comparable to experienced-fellows in real patients, except for significantly longer cross-clamp time[Residents : 76.5(71.7,86.8)vs.Experienced-fellows : 60(53,64) min, p = 0.002]. Conclusions Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.

Background: Congenital left ventricular diverticulum is a rare cardiac malformation usually requiring total resection. Case presentation: This report describes an infant presenting with a large apical diverticulum with a wide ventricle connection. Given the vicinity of the left anterior descending coronary artery to the diverticulum and its wide ventricular connection, partial resection was undertaken. The patient remained asymptomatic with good heart function 8 months after surgery. The last follow-up echocardiography did not demonstrate any significant left ventricular outpouching. Conclusions: We advocate early treatment of left ventricular diverticulum in children given the risk of spontaneous rupture of diverticulum, sudden death, and other serious complications if left untreated. For small patients with a wide connection of diverticulum to ventricle, partial resection is a safe option with favorable short-term outcomes.