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

BACKGROUND: Double 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 majori...

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Autores principales: Brüning, Jan, Kramer, Peter, Goubergrits, Leonid, Schulz, Antonia, Murin, Peter, Solowjowa, Natalia, Kuehne, Titus, Berger, Felix, Photiadis, Joachim, Weixler, Viktoria Heide-Marie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748612/
https://www.ncbi.nlm.nih.gov/pubmed/36531701
http://dx.doi.org/10.3389/fcvm.2022.1024053
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author Brüning, Jan
Kramer, Peter
Goubergrits, Leonid
Schulz, Antonia
Murin, Peter
Solowjowa, Natalia
Kuehne, Titus
Berger, Felix
Photiadis, Joachim
Weixler, Viktoria Heide-Marie
author_facet Brüning, Jan
Kramer, Peter
Goubergrits, Leonid
Schulz, Antonia
Murin, Peter
Solowjowa, Natalia
Kuehne, Titus
Berger, Felix
Photiadis, Joachim
Weixler, Viktoria Heide-Marie
author_sort Brüning, Jan
collection PubMed
description BACKGROUND: Double 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 METHODS: The 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. RESULTS: Median 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. CONCLUSION: Image-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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spelling pubmed-97486122022-12-15 3D modeling and printing for complex biventricular repair of double outlet right ventricle Brüning, Jan Kramer, Peter Goubergrits, Leonid Schulz, Antonia Murin, Peter Solowjowa, Natalia Kuehne, Titus Berger, Felix Photiadis, Joachim Weixler, Viktoria Heide-Marie Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Double 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 METHODS: The 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. RESULTS: Median 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. CONCLUSION: Image-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. Frontiers Media S.A. 2022-11-30 /pmc/articles/PMC9748612/ /pubmed/36531701 http://dx.doi.org/10.3389/fcvm.2022.1024053 Text en Copyright © 2022 Brüning, Kramer, Goubergrits, Schulz, Murin, Solowjowa, Kuehne, Berger, Photiadis and Weixler. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Brüning, Jan
Kramer, Peter
Goubergrits, Leonid
Schulz, Antonia
Murin, Peter
Solowjowa, Natalia
Kuehne, Titus
Berger, Felix
Photiadis, Joachim
Weixler, Viktoria Heide-Marie
3D modeling and printing for complex biventricular repair of double outlet right ventricle
title 3D modeling and printing for complex biventricular repair of double outlet right ventricle
title_full 3D modeling and printing for complex biventricular repair of double outlet right ventricle
title_fullStr 3D modeling and printing for complex biventricular repair of double outlet right ventricle
title_full_unstemmed 3D modeling and printing for complex biventricular repair of double outlet right ventricle
title_short 3D modeling and printing for complex biventricular repair of double outlet right ventricle
title_sort 3d modeling and printing for complex biventricular repair of double outlet right ventricle
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748612/
https://www.ncbi.nlm.nih.gov/pubmed/36531701
http://dx.doi.org/10.3389/fcvm.2022.1024053
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