Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Kumar, Parveen; Bhatia, Mona

doi:10.4250/jcvi.2020.0196

Cited by 9 publications

(14 citation statements)

References 58 publications

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Section: Discussionsupporting

confidence: 60%

“…Furthermore, having 3D printed models allowed ad hoc assessment and evaluation of sizes, shapes, relationships, and orientations of various intracardiac structures. Thus, the general feedback from our clinical center matches the experience from other retrospective studies (10)(11)(12). According to members of the heart team, the main advantage provided by both 3D reconstruction and 3D printing was that different treatment strategies could be elaborated and discussed easier, as the entire intra-cardiac anatomy could be analyzed at once.…”

Section: Benefits Of 3d Reconstruction and 3d Printingsupporting

confidence: 60%

“…3D imaging techniques such as magnetic resonance imaging (MRI) ( 8 ) and computed tomography (CT) ( 9 ) are used increasingly frequent to visualize and analyze the anatomy of different complex congenital heart defects. These techniques allow visualization of the entire cardiovascular anatomy as well as measurements of relevant intracardiac dimensions and volumes ( 10 ). However, the representation of the 3D anatomy using two-dimensional (2D) slices perpendicular to each other, encumbers the assessment of the complex 3D structures and their position and orientation in relation to each other.…”

Section: Introductionmentioning

confidence: 99%

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

Brüning

Krämer

Goubergrits

et al. 2022

Front. Cardiovasc. Med.

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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.

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Section: Discussionsupporting

confidence: 60%

Section: Benefits Of 3d Reconstruction and 3d Printingsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Brüning

Krämer

Goubergrits

et al. 2022

Front. Cardiovasc. Med.

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“…Echocardiography is the key non-invasive diagnostic imaging tool that is usually sufficient to manage most children with heart disease ( 1 , 2 ). However, cross-sectional imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) are increasingly used in pediatric cardiology, and can provide additional anatomical, structural, and functional information ( 3 – 5 ). In adult cardiology, nuclear imaging techniques are used for evaluating myocardial perfusion and viability, pulmonary perfusion, ventricular function, and detection of inflammatory processes.…”

Section: Introductionmentioning

confidence: 99%

Nuclear Imaging in Pediatric Cardiology: Principles and Applications

et al. 2022

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Nuclear imaging plays a unique role within diagnostic imaging since it focuses on cellular and molecular processes. Using different radiotracers and detection techniques such as the single photon emission scintigraphy or the positron emission tomography, specific parameters can be assessed: myocardial perfusion and viability, pulmonary perfusion, ventricular function, flow and shunt quantification, and detection of inflammatory processes. In pediatric and congenital cardiology, nuclear imaging can add complementary information compared to other imaging modalities such as echocardiography or magnetic resonance imaging. In this state-of-the-art paper, we appraise the different techniques in pediatric nuclear imaging, evaluate their advantages and disadvantages, and discuss the current clinical applications.

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“…According to the society of Thoracic Surgeons database, the patients with a DORV are classified into 4 basic types; (a) Fallot type: DORV with subaortic VSD and pulmonary stenosis (PS), (b) VSD type: DORV with doubly committed VSD and no PS, (c) Taussig Bing anomaly: DORV with subpulmonic VSD and D) DORV with remote VSD or atrioventricular septal defect type (AVSD) [1,6,7].…”

Section: Introductionmentioning

confidence: 99%

Is combined MDCT and echocardiography needed to guarantee accuracy in diagnosis and surgical planning of DORV and associated anomalies?

Saraya

Ahmad

Donkol

et al. 2022

Egypt J Radiol Nucl Med

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Background The term of Double-outlet right ventricle (DORV) is used to describe a spectrum of complex congenital cardiac malformations where anomalies of the ventriculo-arterial alignment are noted where both great arteries (pulmonary artery and aorta) originate completely or predominantly from the right ventricle. The purpose of this study is to evaluate the diagnostic accuracy of electrocardiography (ECG) gated multidetector computed tomography (MDCT) in preoperative assessment of DORV and its associated malformations, providing key anatomic parameters that affect surgical planning. Results A total of 50 patients diagnosed by echocardiography with DORV referred from our institute between September 2018 and August 2020 were enrolled. The location of the ventricular septal defect (VSD) to the great vessels and the alignment of the great vessels to each other as well as other associated malformations that affect the surgical planning were assessed by MDCT. The patients were retrospectively classified into subgroups according to the relative positions of the great arteries, the relationship between the great arteries and the VSD, and the presence of associated malformations according to the classification of Society of Thoracic Surgeons database. The diagnostic value of MDCT and transthoracic echocardiography (TTE) in evaluation of associated cardiac malformations apart from double outlet right ventricle was compared in 20 patients, whom surgeries were performed and surgical results were obtained. Fallot type of DORV was the most common clinical type which represented 48% of the patients in which the VSD is committed to the aorta. The second most common clinical type was Taussig–Bing anomaly which represented 30% of the patients and the VSD was seen committed to the pulmonary artery. The atrio-ventricular septal defect (AVSD)/uni-ventricular type represented 16% of the patients in the current study, with pulmonary and systemic venous anomalies, heterotaxy syndrome and situs anomalies were commonly associated. A total of 53 malformations apart from DORV were found in 20 patients whom performed surgical interventions. MDCT detected different vascular and situs anomalies in those patients with 100% sensitivity and 100% positive predictive value compared to 71.4% and 94% respectively in TTE. On the other hand, in our study TTE was superior to MDCT for detection of intracardiac anomalies with 100% sensitivity and 100% accuracy compared to 87.5% and 95% respectively in MDCT. Conclusions Our study suggested that ECG gated MDCT serves as a rapid, noninvasive imaging modality with good spatial resolution and provides excellent diagnostic image quality and has satisfactory diagnostic accuracy in the preoperative assessment of DORV. It is superior to echocardiography in providing a comprehensive mapping of the anatomy of complex anomalies especially that of extra-cardiac structures such as aorta, systemic veins, pulmonary veins, and pulmonary arteries. However, it can miss tiny intracardiac malformations. So combining the results of MDCT and echocardiography would be beneficial to guarantee the accuracy of diagnosis of DORV.

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Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Cited by 9 publications

References 58 publications

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

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

Nuclear Imaging in Pediatric Cardiology: Principles and Applications

Is combined MDCT and echocardiography needed to guarantee accuracy in diagnosis and surgical planning of DORV and associated anomalies?

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