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Physical Models Aiding in Complex Congenital Heart SurgeryDisclaimer

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Purpose

Our aim was to improve spatial imagination of complex congenital cardiac abnormalities for subsequent surgical intervention.

Description

Magnetic resonance imaging data of a patient with complex congenital heart malformations was post-processed with software developed at our institution. The resulting virtual surface data sets were printed out three-dimensionally by rapid prototyping techniques.

Evaluation

We present the first patient operated on with intraoperative use of physical models representing the intracardiac volumes (RepliCast) or muscle and vessel walls (RepliCardio). The courses of the coronary arteries were visible on the RepliCast, whereas the RepliCardio showed intracardiac views a surgeon could never obtain intraoperatively in the relaxed heart. Other than on virtual reconstructions presented on computer screens, physical models vastly improve the spatial imagination and give precise information regarding localization and actual size of abnormal structures. The self-explanatory utility of these models shortened preparation and expedited orientation on the open heart.

Conclusions

The additional spatial information provided by RepliCast and RepliCardio models may enable even high-risk correction procedures in patients with complex congenital heart disease.

Section snippets

Technology

RepliCast (Fig 1) and RepliCardio (Fig 2) models were produced based on 3-D MRI data (Fig 3). The first patient operated on with additional intraoperative orientation using physical models was 24 years old and had the diagnosis of transposition of the great arteries, pulmonary atresia, large ventricular septal defect, atrial septal defect, tricuspid regurgitation, and dextrocardia. He had had several surgical interventions including aortopulmonary anastomosis after birth, at the age of 6 and 7

Technique

A 3-D whole-heart, navigator-corrected MRI data set with nearly isotropic voxel size was acquired using a 1.5 Tesla scanner (Philips Intera CV, Best, NL; Intera 1.5T, Philips Medical Systems, Hamburg, Germany) during free breathing. The data set consisted of 175 slices with a resolution of 1.2 mm (reconstructed, 0.7 × 0.7 × 0.9 mm). The following sequence measurements were used: electrocardiographic gating, slice orientation = axial, single phase, field of view = 360, matrix = 304, repetition

Clinical Experience

There was a clear advantage of the physical printouts represented by the RepliCast (Fig 1) and RepliCardio (Fig 2) for the preoperative virtual 3-D presentations (Fig 4). Spatial imagination of the exact positions and sizes of highly complex abnormal structures were simplified by direct comparison between physical models and the living heart. Other than the beating or cardioplegic heart, the RepliCast and RepliCardio models were able to present formerly unobtainable insights and they provided

Comment

In comparison to 3-D presentations, which are becoming routinely available for MRI, CT scans, and even echocardiography, our 3-D visualizations (Fig 4) can be additionally viewed with red-blue glasses or special 3-D computer screens for optimal spatial imagination. However, human sense can easily be deceived, especially concerning unfamiliar objects perceiving, for example, a human nose in front of the ears, even when a model shows it vice versa. Therefore, even the most experienced surgeons

Disclosures and Freedom of Investigation

Software was developed within the special research area 414 (computer and sensor-guided surgery), which was financed by the Deutsche Forschungsgemeinschaft (German research association). Amy Juraszek is supported by grant no. P50 HL074734-01. The authors had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the written report. The tested technology was not purchased.

References (14)

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Disclaimer

The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.

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