3D modeling and printing for complex biventricular repair of double outlet right ventricle

Abstract

BackgroundDouble outlet right ventricle (DORV) describes a group of congenital heart defects where pulmonary artery and aorta originate completely or predominantly from the right ventricle. The individual anatomy of DORV patients varies widely with multiple subtypes classified. Although the majority of morphologies is suitable for biventricular repair (BVR), complex DORV anatomy can render univentricular palliation (UVP) the only option. Thus, patient-specific decision-making is critical for optimal surgical treatment planning. The evolution of image processing and rapid prototyping techniques facilitate the generation of detailed virtual and physical 3D models of the patient-specific anatomy which can support this important decision process within the Heart Team.Materilas and methodsThe individual cardiovascular anatomy of nine patients with complex DORV, in whom surgical decision-making was not straightforward, was reconstructed from either computed tomography or magnetic resonance imaging data. 3D reconstructions were used to characterize the morphologic details of DORV, such as size and location of the ventricular septal defect (VSD), atrioventricular valve size, ventricular volumes, relationship between the great arteries and their spatial relation to the VSD, outflow tract obstructions, coronary artery anatomy, etc. Additionally, physical models were generated. Virtual and physical models were used in the preoperative assessment to determine surgical treatment strategy, either BVR vs. UVP.ResultsMedian age at operation was 13.2 months (IQR: 9.6-24.0). The DORV transposition subtype was present in six patients, three patients had a DORV-ventricular septal defect subtype. Patient-specific reconstruction was feasible for all patients despite heterogeneous image quality. Complex BVR was feasible in 5/9 patients (55%). Reasons for unsuitability for BVR were AV valve chordae interfering with potential intraventricular baffle creation, ventricular hypoplasia and non-committed VSD morphology. Evaluation in particular of qualitative data from 3D models was considered to support comprehension of complex anatomy.ConclusionImage-based 3D reconstruction of patient-specific intracardiac anatomy provides valuable additional information supporting decision-making processes and surgical planning in complex cardiac malformations. Further prospective studies are required to fully appreciate the benefits of 3D technology.

The effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases: objectives and design of a randomized controlled trial

“…For soft tissues, an average of +100 to +300 has been specified, while for harder tissues such as bone, up to +1900 HU has been reported. [37][38][39] For this study, the average minimum value for masking ventricles and large vessels was set between 80 and 200 HU 40 Threshold values of min 216 HU -max 1502 HU were used. At these HU values, the blood in the heart and great vessels was masked, and the outline of the heart was revealed.…”

Double outlet right ventricle – the 50% rule has always been about the conus

“…However, given the heterogeneity of the underlying anatomy and its impact on surgical outcomes, many complex DORV lesions benefit from preoperative cross-sectional imaging with CT or MRI and 3D model generation for surgical planning [22 ▪ ]. These 3D models of patient-specific anatomy allow assessment of the position and size of the VSD and its location relative to the great arteries, the distance between the tricuspid and pulmonary valves, the presence of overlying or straddling atrioventricular valve tissue, ventricular volumes, coronary artery anatomy, the extent of sub-arterial conus, and the relationship of the great arteries to each other [23 ▪ ]. Additionally, surgical repair options can be modeled.…”