- Poster presentation
- Open Access
Utility of rapid prototyping in Complex DORV: does it alter management decisions?
https://doi.org/10.1186/1532-429X-18-S1-P175
© Bhatla et al. 2016
- Published: 27 January 2016
Keywords
- Ventricular Septal Defect
- Ventricular Septal Defect
- Sequence Magnetic Resonance
- Double Outlet Right Ventricle
- Compute Tomography Angiography Image
Background
Complex ventricular-arterial (VA) relationships in patients with double outlet right ventricle (DORV) make preoperative assessment of potential repair pathways challenging. The relationship of the ventricular septal defect (VSD) to one or both great arteries must be understood and this influences the choice of surgical procedure [1] In neonates and infants with DORV, Computed Tomography (CT) is often performed due to the ability to get high spatial resolution and ECG gated images [2], however it is possible to get the necessary information from Magnetic Resonance (MR) imaging with an added advantage of avoiding exposure to ionizing radiation. Both CT and MR allow image acquisition in three dimensions (3D) but traditional viewing of the anatomy using the multiplanar reformatting is actually done in two dimensions (2D). Volume rendering from either modality may also be performed, but typically only the external vascular anatomy is depicted. We hypothesized that it is possible to accurately define the intracardiac anatomy in infants with DORV using virtual and physical 3D printed (rapid prototyped) models created from either MR or CT and this can both aid in better defining potential VA pathways and may assist in surgical decision making.
Methods
a) segmentation masks, b) virtual models, and c) 3D printed models for all patients.
Results
Patient Demographics and Surgical Plan
Age | Diagnosis | Imaging Modality | Initial Surgical Plan | Additional Information Gained from Model | Final Surgical Intervention | |
|---|---|---|---|---|---|---|
Patient 1 | 1 week | DORV (S,D,D), Doubly committed VSD | CTA | VSD to Ao baffle | VSD-Ao baffle interferes with the RV to PA pathway | Yasui with RV to PA conduit |
Patient 2 | 6 months | DORV (S,D,D), unclear VA relationship | MRA | VSD to PA baffle with arterial switch | Area of tunnel like sub PS is inferior to the LV-VSD-Ao pathway | BT shunt with future plan of LV to Ao baffle and RV-PA conduit |
Patient 3 | 8 weeks | DORV (S,D,D), Subpulmonary VSD, pulmonary stenosis | MRA | Glenn surgery | Confirmed that potential attachment site of AV valve interferes with the VSD-Ao baffle | Glenn surgery |
Conclusions
Construction of 3D models in patients with DORV is feasible and allows for extensive examination and surgical planning. This may facilitate a focused and informed surgical procedure and improve the potential for successful outcome. For purposes of DORV, non-gated MRA is sufficient to delineate the VA relationships adequately for 3D printing and enhanced clinical decision-making. CT imaging should be reserved for only those patients where additional information like coronary artery anatomy is desired.
Authors’ Affiliations
Copyright
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
