Toward predictive modeling of catheter‐based pulmonary valve replacement into native right ventricular outflow tracts

Abstract

Background Pulmonary insufficiency is a consequence of transannular patch repair in Tetralogy of Fallot (ToF) leading to late morbidity and mortality. Transcatheter native outflow tract pulmonary valve replacement has become a reality. However, predicting a secure, atraumatic implantation of a catheter‐based device remains a significant challenge due to the complex and dynamic nature of the right ventricular outflow tract (RVOT). We sought to quantify the differences in compression and volume for actual implants, and those predicted by pre‐implant modeling. Methods We used custom software to interactively place virtual transcatheter pulmonary valves (TPVs) into RVOT models created from pre‐implant and post Harmony valve implant CT scans of 5 ovine surgical models of TOF to quantify and visualize device volume and compression. Results Virtual device placement visually mimicked actual device placement and allowed for quantification of device volume and radius. On average, simulated proximal and distal device volumes and compression did not vary statistically throughout the cardiac cycle (P = 0.11) but assessment was limited by small sample size. In comparison to actual implants, there was no significant pairwise difference in the proximal third of the device (P > 0.80), but the simulated distal device volume was significantly underestimated relative to actual device implant volume (P = 0.06). Conclusions This study demonstrates that pre‐implant modeling which assumes a rigid vessel wall may not accurately predict the degree of distal RVOT expansion following actual device placement. We suggest the potential for virtual modeling of TPVR to be a useful adjunct to procedural planning, but further development is needed.

SlicerHeart: An open-source computing platform for cardiac image analysis and modeling

“…Segmentation can be performed on any data, including 3DE using the tools we have released, using the Segment Editor and Segment Editor Extra Effects modules we have created ( 31 ). Customized workflows can then be created for dedicated processes such as the segmentation and modeling of specific structures ( 32 , 33 ). For example, segmentation of heart valves can be difficult, and benefits from dedicated workflows to procedurally align images for optimal identification of the valve annulus and leaflets.…”

“…We have recently demonstrated utilization of a new functionality within SlicerHeart called the Cardiac Device Simulator Module which we employed to model virtual placement of an evolving group of cardiac devices ( Figure 8 ). We have customized workflows for a diverse group of transcatheter procedures including self-expanding transcatheter pulmonary valves in CT datasets and transcatheter atrial and ventricular septal occlusion devices within 3DE datasets ( Figure 8 ) ( 22 , 32 , 40 ). Further specialization of this general toolkit has now been implemented to support the modeling of transcatheter mitral valves and transcatheter edge-to-edge therapies which we have recently demonstrated ( Figure 9 ) ( 7 , 23 ).…”

Development of a Clinical 3D Modeling Program to Guide Pediatric Cardiothoracic Surgery and Intervention

“…There is a plethora of literature describing the advantages of utilizing 3D modeling and visualization techniques for procedural planning in both pediatric and adult cardiology. [1][2][3][4][5][6][7][8][9] In patients with congenital heart disease much of the published data focuses on using 3D printing and more recently virtual or augmented reality, to inform surgical planning for patients with complex intracardiac anatomy such as double outlet right ventricle. [10][11][12][13][14] As a result of the improved visuospatial understanding of patient speci c cardiac lesions conferred by viewing 3D representations of the anatomy, these 3D tools are heralded as bene cial adjunctive imaging tools that bring added-value to the preoperative planning space.…”

Successful integration of a three‐dimensional transthoracic echocardiography‐derived model with an electroanatomic mapping system to guide catheter ablation of WPW

“…Three-dimensional transthoracic echocardiography (3DE)-derived heart models are emerging as a powerful imaging tool for the planning of both surgical and transcatheter interventions. 1,2 We, therefore, sought to evaluate whether 3DE models could feasibly be imported using the CARTO-Merge module, in a manner analogous to importing CT or MRI anatomical data.…”

“…In contrast, transthoracic echocardiography (TTE) is often a standard component of preprocedural evaluation and has negligible risk; three‐dimensional imaging can be acquired as part of routine TTE with minimal added time or cost. Three‐dimensional transthoracic echocardiography (3DE)‐derived heart models are emerging as a powerful imaging tool for the planning of both surgical and transcatheter interventions 1,2 . We, therefore, sought to evaluate whether 3DE models could feasibly be imported using the CARTO‐Merge module, in a manner analogous to importing CT or MRI anatomical data.…”