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ABSTRACT: BACKGROUND: We analyzed risks for severe morbidity in the early period after extracardiac Fontan operation. METHODS: Between November 1995 and May 2011, 140 patients (median age, 3.8 years) underwent extracardiac Fontan operation. We assumed as preoperative risk factors systemic right ventricle (n = 51), heterotaxia (n = 25), arterial oxygen saturation less than 75% (n = 22), and adult age (>16 years, n = 20) at time of surgery. Prolonged cardiopulmonary bypass time of longer than 120 minutes (n = 30) and use of cardioplegia (n = 26) were analyzed as intraoperative risks. RESULTS: Heterotaxia was revealed as a risk factor for postoperative prolonged inotropic support, acute renal failure, prolonged mechanical ventilation, prolonged pleural effusions, and tachyarrhythmias. With the exception of pleural effusions, the same held true for right ventricle morphology. Low preoperative arterial oxygen saturation was found to be associated with an increased risk of prolonged inotropic support, acute renal failure, and prolonged mechanical ventilation. Adult age was identified as a risk factor for acute renal failure. Of the intraoperative factors, prolonged cardiopulmonary bypass time longer than 120 minutes was a risk factor for acute renal failure and prolonged pleural effusions, whereas use of cardioplegia was associated with an increased risk of prolonged inotropic support, prolonged mechanical ventilation, acute renal failure, and tachyarrhythmias. Multivariate analysis demonstrated heterotaxia, right ventricular morphology, and low preoperative arterial oxygen saturation to be independent risk factors for postoperative prolonged inotropic support and prolonged mechanical ventilation. CONCLUSIONS: Patients with heterotaxia, systemic right ventricle, and low preoperative arterial oxygen saturation are still at high risk for early Fontan failure after extracardiac Fontan operation and require special management for optimal outcome.
The Annals of thoracic surgery 02/2013; · 3.74 Impact Factor
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ABSTRACT: Femoral arterial thrombosis (FAT) is a nonnegligible complication after cardiac catheterization (CC) in infancy. The aim of this study was to evaluate the impact of Doppler ultrasound (US) for diagnostic work-up after catheterization. We compared standard follow-up (FU) without Doppler US by relying on clinical signs of FAT with advanced FU using Doppler US of the femoral vessels. Between January and December 2009, we evaluated the rate of FAT in infants <12 months of age using a multicenter, prospective observational survey. We analysed 171 patients [mean age 4.1 ± 3.3 (SD) months; mean body weight 5.3 ± 1.8 kg] from 6 participating centres. The mean duration of catheter studies was 57.7 ± 38.0 min. The overall rate of FAT based on clinical diagnosis was 4.7 % and was comparable in both groups [3.4 % undergoing standard FU vs. 7.4 % undergoing advanced FU (p = 0.15)]. However, the overall rate of thrombosis as screened by Doppler US was greater at 7.1 %, especially in patients after advanced FU [18.5 % advanced vs. standard FU 1.7 % (p < 0.01)]. In conclusion, FAT remains a relevant and underestimated complication after catheterization in young infants when relying only on clinical signs of FAT. Therefore, to start effective treatment as soon as possible, we recommend Doppler US to be performed the day after CC.
Pediatric Cardiology 09/2012; · 1.30 Impact Factor
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ABSTRACT: Interventional closure of atrial septal defects (ASDs) with a transcatheter device is the preferred strategy in children and adults. This procedure has been proven in numerous studies, but X-ray and contrast agent exposure is still a major side effect. The aim of this study was to clarify whether the interventional closure of ASDs is possible and safe if it is guided by transesophageal echocardiography (TEE) alone.
We retrospectively selected and studied pediatric and adult patients with interventional closure of ASDs at the Deutsches Herzzentrum Berlin (DHZB) without fluoroscopy between 1999 and 2010. We included 330 out of 1,605 patients; 254 had an ASD II, 30 a PFO and 46 multiperforated atrial septum. Median age was 8.92 (0.96-76.3) years and median body weight 32.6 (8.3-156) kg. Median stretched defect size was 13 (5-29) mm. Median procedure time was 50 (20-170) min. Closure was performed in the majority of patients with the Amplatzer(®) septal occluder or Amplatzer(®) PFO occluder. The procedure succeeded in 98.2 % of cases and closure rate was 94.9 % after 48 h. Complication rate was low and procedure time was similar to that necessary with studies using fluoroscopy.
Interventional closure of ASDs is safe and effective if guided with TEE alone. The results can compete with those with the use of fluoroscopy. TEE-guided closure of ASD should be considered in more catheter laboratories to avoid unnecessary radiation exposure for the patient and the examiner.
Clinical Research in Cardiology 03/2012; 101(9):691-700. · 2.95 Impact Factor
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ABSTRACT: The aim of this animal study was to establish a shunt connection between superior vena cava (SVC) and right pulmonary artery (RPA) by transvascular intervention solely.
After initial shunt creation, the establishment of the upper cavo-pulmonary anastomosis (UCPA) is the second out of three open chest operations young infants with univentricular anatomy are subjected to. To avoid the risks of reoperation with cardiovascular bypass, we sought to replace this surgical step by an interventional technique.
After cannulation of jugular and femoral veins in four piglets (mean body weight of 12.5 kg) an UCPA was created by radiofrequency perforation from the SVC across the right atrium into the RPA and subsequent implantation of covered stents. The perforation was guided by biplane fluoroscopy and the perforation wire premounted with a coaxial catheter was advanced into the distal pulmonary artery and exchanged for a stiffer wire. A long sheath was brought into the RPA and an 80 mm long expanded poly-tetra-fluoro-ethylene (ePTFE)-covered Cheatham Platinum stent was then implanted connecting the SVC with the RPA.
Immediate angiography showed antegrade flow from SVC to RPA. Angiographic re-evaluation after a median period of 4 weeks showed partial in-stent stenosis but patent lumina. Additionally, veno-venous collaterals from the SVC to the right atrium had developed. Histology of the explanted stents revealed parietal thrombi and mild to moderate pseudo intima proliferation inside the lumina.
The transvascular creation of an upper unidirectional cavo-pulmonary anastomosis in piglets is technically feasible using standard catheterization equipment.
Catheterization and Cardiovascular Interventions 03/2012; 80(1):93-9. · 2.29 Impact Factor
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ABSTRACT: A young woman presented with severe heart failure symptoms 4 years after percutaneous device closure of an atrial septal defect (ASD). There was residual left-to-right shunting, and the device was obstructing the inferior caval vein and tricuspid valve flow. Intraoperatively, the ASD was shown to be an inferior sinus venosus defect, and reconstruction of the mitral valve and the posterior wall of the left atrium was required. This case emphasizes the importance of appropriate patient selection for interventional ASD closure and demonstrates that patients with less-than-optimal results should be referred for surgical correction early, before the device produces secondary damage to atrial structures and atrioventricular valves.
Interactive cardiovascular and thoracic surgery 01/2012; 14(4):485-7.
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ABSTRACT: The Cardio QP™ oesophageal Doppler monitor measures the velocity time integral of the blood flow in the descending aorta. Based on system integrated normograms of the aortic cross-sectional area of a paediatric population, the cardiac output is calculated and displayed.
Evaluation of the capability of the Cardio QP™ to detect changes in cardiac output during desynchronizing ventricular pacing (VVI) in children after cardiac surgery.
Eleven children (6 female, 5 male) with epicardial pacemaker electrodes admitted to the paediatric intensive care unit (PICU) after corrective surgery for congenital heart defects. Mean age: 6.3 (2.1-15.0) months, mean body weight: 5.3 (3.5-7.8) kg.
After baseline measurements of cardiac output (base I), we performed 3 steps, each lasting 5 min: (1) ventricular pacing (VVI), (2) baseline (base II) recording, (3) atrial pacing (AOO). We measured the effects on haemodynamic parameters and blood gases as well as on the measured cardiac output.
Ventricular pacing, with atrio-ventricular dyssynchrony, led to a significant drop in blood pressure and central venous saturation. Cardiac output parameters showed a decrease in stroke volume (SV) from 4.9±2.2 to 4.2±2.1 ml (P = 0.005) and cardiac index (CI) (2.6±1.1-2.1±0.8 ml/min/m(2)) (P = 0.009) during ventricular pacing. Cardiac index and haemodynamic parameters during atrial stimulation did not show significant changes from baseline.
The Cardio QP™ seems to be capable of detecting slight changes in cardiac output.
International Journal of Clinical Monitoring and Computing 11/2011; 25(6):419-25.
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Philip A Roberts,
Younes Boudjemline,
John P Cheatham,
Andreas Eicken, Peter Ewert,
Doff B McElhinney,
Sharon L Hill,
Felix Berger,
Danyal Khan,
Dietmar Schranz,
John Hess,
Michael D Ezekowitz,
David Celermajer,
Evan Zahn
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ABSTRACT: This study sought to describe the first human series of percutaneous tricuspid valve replacements in patients with congenital or acquired tricuspid valve (TV) disease.
Percutaneous transcatheter heart valve replacement of the ventriculoarterial (aortic, pulmonary) valves is established. Although there are isolated reports of transcatheter atrioventricular heart valve replacement (hybrid and percutaneous), this procedure has been less frequently described; we are aware of no series describing this procedure for TV disease.
We approached institutions with significant experience with the Melody percutaneous pulmonary valve (Medtronic, Inc., Minneapolis, Minnesota) to collect data where this valve had been implanted in the tricuspid position. Clinical and procedural data were gathered for 15 patients. Indications for intervention included severe hemodynamic compromise and perceived high surgical risk; all had prior TV surgery and significant stenosis and/or regurgitation of a bioprosthetic TV or a right atrium-to-right ventricle conduit.
Procedural success was achieved in all 15 patients. In patients with predominantly stenosis, mean tricuspid gradient was reduced from 12.9 to 3.9 mm Hg (p < 0.01). In all patients, tricuspid regurgitation was reduced to mild or none. New York Heart Association functional class improved in 12 patients. The only major procedural complication was of third-degree heart block requiring pacemaker insertion in 1 patient. One patient developed endocarditis 2 months after implant, and 1 patient with pre-procedural multiorgan failure did not improve and died 20 days after the procedure. The remaining patients have well-functioning Melody valves in the TV position a median of 4 months after implantation.
In selected cases, patients with prior TV surgery may be candidates for percutaneous TV replacement.
Journal of the American College of Cardiology 07/2011; 58(2):117-22. · 14.16 Impact Factor
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Ina Michel-Behnke, Peter Ewert,
Andreas Koch,
Harald Bertram,
Mathias Emmel,
Gunther Fischer,
Roland Gitter,
Rainer Kozlik-Feldman,
Reinald Motz,
Erwin Kitzmüller,
Oliver Kretschmar
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ABSTRACT: This study reports on the feasibility, efficacy, and outcome of hybrid procedures to close ventricular septal defects (VSD), reflecting the experience of 11 centers in Germany, Austria, and Switzerland.
Beating heart closure of VSD has attracted interest in small infants, complex anomalies and postinfarction scenarios where patients are at high risk during surgery. Perventricular or intraoperative device placement allows access to the lesions where percutaneous delivery is limited.
Between December 2001 and April 2009, placement of Amplatzer septal occluders was attempted in 26 patients. The defects were located in the perimembranous (n = 5) and muscular septum (n = 21). In 20 patients, a perventricular approach was used, and, in six, the occluders were placed under direct visualization being part of a complex heart surgery. Results: In 23 of 26 procedures, device placement was successful (88.5%). The mean defect size was 7.8 mm (range, 3.5-20). The occluder types were perimembranous VSD occluder (n = 4), muscular VSD occluder (n = 20), postinfarct VSD occluder (n = 1), and ASD occluder (n = 1) with a ratio device/defect of 0.9-2.4 (median 1.15). Device removal was necessary in three due to arrhythmia, malpositioning, and additional defects. Pericardial effusion occurred once. In the remaining 22 patients, there were no procedure or device-related complications. During mean follow up of 1.4 years (range, 1 day-3.9 years), a residual shunt that was more than trivial was observed in one patient out of 21 successful procedures.
Perventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of high-risk patients.
Catheterization and Cardiovascular Interventions 02/2011; 77(2):242-51. · 2.29 Impact Factor
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Clinical Research in Cardiology 01/2011; 100(1):85-7. · 2.95 Impact Factor
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ABSTRACT: Dysfunction of valved conduits in the right ventricular outflow tract (RVOT) limits durability and enforces repeated surgical interventions. We report on our combined two-centre experience with percutaneous pulmonary valve implantation (PPVI).
One hundred and two patients with RVOT dysfunction [median weight: 63 kg (54.2-75.9 kg), median age: 21.5 years (16.2-30.1 years), diagnoses: TOF/PA 61, TAC 14, TGA 9, other 10, AoS post-Ross-OP 8] were scheduled for PPVI since December 2006. Percutaneous pulmonary valve implantation was performed in all patients. Pre-stenting of the RVOT was done in 97 patients (95%). The median peak systolic RVOT gradient decreased from 37 mmHg (29-46 mmHg) to 14 mmHg (9-17 mmHg, P < 0.001) and the ratio RV pressure/AoP decreased from 62% (53-76%) to 36% (30-42%, P < 0.0001). The median end-diastolic RV-volume index (MRI) decreased from 106 mL/m(2) (93-133 mL/m(2)) to 90 mL/m(2) (71-108 mL/m(2), P = 0.001). Pulmonary regurgitation was significantly reduced in all patients. One patient died due to compression of the left coronary artery. The incidence of stent fractures was 5 of 102 (5%). During follow-up [median: 352 days (99-390 days)] one percutaneous valve had to be removed surgically 6 months after implantation due to bacterial endocarditis. In 8 of 102 patients, a repeated dilatation of the valve was done due to a significant residual systolic pressure gradient, which resulted in a valve-in-valve procedure in four.
This study shows that PPVI is feasible and it improves the haemodynamics in a selected patient collective. Apart from one coronary compression, the rate of complications at short-term follow-up was low. Percutaneous pulmonary valve implantation can be performed by experienced interventionalists with similar results as originally published. The intervention is technically challenging and longer clinical follow-up is needed.
European Heart Journal 01/2011; 32(10):1260-5. · 10.48 Impact Factor
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ABSTRACT: We analyzed the potential of endovascular stent grafts to treat late aortic pseudoaneurysms after coarctation repair.
Eight patients (7 male; age 28 to 58, mean 43 years) presented with aortic pseudoaneurysms after primary repair performed at the age of 5 to 27 (mean 12) years; 2 patients had rupture with hemorrhagic shock. The mean interval between the procedures was 31 (19 to 42) years; one patient had 3 previous operations. This subset represents 2.2% of our overall experience in thoracic endovascular repair (n=368). Thoracic endografts were implanted using the transfemoral technique. Custom-made reverse tapered stent grafts were used in 4 cases. The left subclavian artery (LSA) was covered in 5 patients. Protective transposition of the left subclavian artery was performed in 4 patients.
Hospital mortality was 12.5%; 1 patient died from secondary rupture after emergency repair. Primary complete exclusion of the aneurysm was achieved in 6 patients. Secondary exclusion after implantation of a second stent graft was successful in the second rupture patient. No endoleak was present at discharge. All discharged patients are alive after 8 to 63 (mean 36) months. Follow-up computed tomography or transesophageal echocardiography revealed no secondary endoleaks or late expansion. The pseudoaneurysms had shrunk completely in 3 patients, were reduced in size in 2 patients, and remained unchanged in 2 patients. No late secondary interventions were noted.
Single piece, reversed, tapered stent grafts adapt better to the special anatomy of the hypoplastic aortic arch. Midterm results are excellent; complete shrinkage in 50% is remarkable. However, the long-term behavior of these implants in young patients requires further evaluation and surveillance.
The Annals of thoracic surgery 01/2011; 91(1):85-91. · 3.74 Impact Factor
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Circulation Cardiovascular Interventions 12/2010; 3(6):e26-8. · 6.06 Impact Factor
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European Heart Journal 10/2010; 32(5):531-4. · 10.48 Impact Factor
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ABSTRACT: The role, interplay, and relative importance of the multifactorial hemodynamic and myocardial mechanisms causing dysfunction of the Fontan circulation remain incompletely understood.
Using an MRI catheterization technique, we performed a differential analysis of pulmonary vascular resistance and aortopulmonary collateral blood flow in conjunction with global ventricular pump function, myocontractility (end-systolic pressure-volume relation), and diastolic compliance (end-diastolic pressure-volume relation) in 10 patients with a Fontan circulation at rest and during dobutamine stress. Pulmonary and ventricular pressures were measured invasively and synchronized with velocity-encoded MRI-derived pulmonary and aortic blood flows and cine MRI-derived ventricular volumes. Pulmonary vascular resistance and end-systolic and end-diastolic pressure-volume relations were then determined. Aortopulmonary collateral flow was calculated as the difference between aortic and pulmonary flow. Compared to rest, dobutamine caused a small increase in mean pulmonary pressures (P<0.05). Collateral flow was significantly augmented (P<0.001) and contributed importantly to an increase in pulmonary flow (P<0.01). Pulmonary vascular resistance decreased significantly (P<0.01). Dobutamine did not increase stroke volumes significantly despite slightly enhanced contractility (end-systolic pressure-volume relation). Active early relaxation (τ) was inconspicuous, but the end-diastolic pressure-volume relation shifted upward, indicating reduced compliance.
In patients with a Fontan circulation, aortopulmonary collateral flow contributes substantially to enhanced pulmonary flow during stress. Our data indicate that pulmonary vascular response to augmented cardiac output was adequate, but decreased diastolic compliance was identified as an important component of ventricular dysfunction.
Circulation Cardiovascular Imaging 09/2010; 3(5):623-31. · 5.94 Impact Factor
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ABSTRACT: Since 1988, a modified repair technique has been used at the authors' institution to treat patients with Ebstein's anomaly. This technique restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure, without plication of the atrialized chamber. A total of 19 patients had additional attachment of the anterior right ventricular wall to the interventricular septum (Sebening's stitch) and reconstruction of the tricuspid valve as a double-orifice valve. The long-term results of the study are presented.
Between 1988 and 2008, tricuspid valve repair was performed in 50 patients with Ebstein's anomaly (33 females, 17 males; median age 22 years; range: 0.6 to 60 years), at the authors' institution. The median follow up was 68 months (range: 5 to 238) months. Details of the survival rate, reoperations, NYHA class, maximal VO2, right ventricular function (velocity-time integral pulmonary artery (VTI-PA)), and tricuspid valve insufficiency were documented.
No patient deaths occurred during surgery; the early mortality was 7.1%, and late mortality 2.4%. Those patients who died were all aged > 50 years, and in NYHA class III or IV. No additional patient deaths have occurred since 2004. Four reoperations were necessary. Both, the NYHA class and tricuspid valve insufficiency were improved significantly (from 3.1 to 1.8; p < 0.001 and from 3.2 to 1.9; p < 0.001, respectively). The VTI-PA was increased significantly, with a stable heart rate (p = 0.01). No aneurysm of the right ventricle was observed.
The long-term follow up demonstrated good clinical results in tricuspid repair, without plication of the right ventricle, even in cases where tricuspid valve replacement was discussed. Modifications seemed to support these results. Surgery in older patients with a progressive NYHA class seemed to carry a higher operative mortality.
The Journal of heart valve disease 05/2010; 19(3):364-9; discussion 370. · 0.81 Impact Factor
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ABSTRACT: The brain of children in the early period after repair of congenital heart defects with cardiopulmonary bypass (CPB) may be more vulnerable to hemodynamic changes because of impaired cerebral autoregulation. During postoperative testing of the external temporary safety pacer, we performed desynchronizing ventricular pacing (VVI) while monitoring cerebral oxygenation using near-infrared spectroscopy (NIRS).
We prospectively investigated 11 children (6 girls, 5 boys). Mean age was 6.1 months (+/-3.8 months) and mean weight: 5.3 kg (+/-1.5 kg). We performed measurements at four study steps: baseline I, VVI pacing, baseline II and atrial pacing (AOO) to exclude effects of higher heart rate. We continuously measured the effects on hemodynamic and respiratory parameters as well as on cerebral tissue oxygenation index (TOI). Hemoglobin difference (HbD) was calculated as a parameter for cerebral blood flow (CBF).
Ventricular pacing leads to a significant decrease in arterial blood pressure and central venous saturation accompanied by an immediate and significant decrease in TOI (63.3% +/- 7.6% to 61.5% +/- 8.4% [P < 0.05]) and HbD (0.51 +/- 1.8 micromol.l(-1) to -2.9 +/- 4.7 micromol.l(-1) [P < 0.05]).
Cardiac desynchronization after CPB seems to reduce CBF and cerebral oxygenation in children.
Pediatric Anesthesia 04/2010; 20(6):553-8. · 2.10 Impact Factor
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JACC. Cardiovascular imaging 03/2010; 3(3):328-9. · 14.29 Impact Factor
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Titus Mbah Sabi,
Boris Schmitt,
Matthias Sigler,
Keyhan Sayadpour Zanjani,
Stanislav Ovroutski,
Bjoern Peters,
Oliver Miera,
Nicole Nagdyman,
Titus Kuehne,
Felix Berger, Peter Ewert
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ABSTRACT: The surgical creation of an aortopulmonary shunt is an important tool in the therapy of complex congenital heart defects. We report on a transcatheter approach to establish an aortopulmonary shunt in piglets.
In 10 piglets with a median body weight of 10.5 kg (8-12 kg), a central aortopulmonary shunt was created by radiofrequency perforation from the aorta to the pulmonary trunk, followed by stent implantation. The procedures were performed via the femoral vessels through 5F sheaths under biplane fluoroscopy guidance. A total of six bare metal coronary stents and five polytetrafluoroethylene-covered coronary stents of 3-4 mm diameter were deployed. Four animals were sacrificed immediately after intervention; six pigs were reevaluated 4-5 weeks later for stent patency and measurement of shunt volume. The procedure was successful in all pigs. Median shunt volume was Qp:Qs = 2.4:1. At re-evaluation median body weight had increased to 18 kg (15.5-27.5 kg) P < 0.028. Four of six stents were completely obstructed due to tissue ingrowth in the bare metal stents (two cases) and thrombus formation in the covered stents (two cases). A third bare metal stent had a residual lumen, and a third covered stent was fully open without any thrombus formation or tissue ingrowth.
Transcatheter creation of an aortopulmonary shunt by radiofrequency perforation and stent implantation is feasible. The use of appropriate covered stents and an effective anticoagulatory regimen seem to be crucial to keep the shunts open.
Catheterization and Cardiovascular Interventions 03/2010; 75(4):563-9. · 2.29 Impact Factor
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ABSTRACT: This study sought to develop and validate a method for the integrated analysis of systolic and diastolic ventricular function.
An integrated approach to assess ventricular pump function, myocontractility (end-systolic pressure-volume relationship [ESPVR]), and diastolic compliance (end-diastolic pressure-volume relation [EDPVR]) is of high clinical value. Cardiac magnetic resonance (CMR) is well established for measuring global pump function, and catheterization-combined CMR was previously shown to accurately measure ESPVR, but not yet the EDPVR.
In 8 pigs, the CMR technique was compared with conductance catheter methods (gold standard) for measuring the EDPVR in the left and right ventricle. Measurements were performed at rest and during dobutamine administration. For CMR, the ESPVR was estimated with a single-beat approach by synchronizing invasive ventricular pressures with cine CMR-derived ventricular volumes. The EDPVR was determined during pre-load reduction from additional volume data that were obtained from real-time velocity-encoded CMR pulmonary/aortic blood flow measurements. Pre-load reduction was achieved by transient balloon occlusion of the inferior vena cava. The stiffness coefficient beta was calculated by an exponential fit from the EDPVR. After validation in the animal experiments, the EDPVR was assessed in a pilot study of 3 patients with a single ventricle using identical CMR and conductance catheter techniques.
Bland-Altman tests showed good agreement between conductance catheter-derived and CMR-derived EDPVR. In both ventricles of the pigs, dobutamine enhanced myocontractility (p < 0.01), increased stroke volume (p < 0.01), and improved diastolic function. The latter was evidenced by shorter early relaxation (p < 0.05), a downward shift of the EDPVR, and a decreased stiffness coefficient beta (p < 0.05). In contrast, in the patients, early relaxation was inconspicuous but the EDPVR shifted left-upward and the stiffness constant remained unchanged. The observed changes in diastolic function were not significantly different when measured with conductance catheter and CMR.
This novel CMR method provides differential information about diastolic function in conjunction with parameters of systolic contractility and global pump function.
JACC. Cardiovascular imaging 11/2009; 2(11):1271-81. · 14.29 Impact Factor
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Eugénie Riesenkampff,
Urte Rietdorf,
Ivo Wolf,
Bernhard Schnackenburg, Peter Ewert,
Michael Huebler,
Vladimir Alexi-Meskishvili,
Robert H Anderson,
Nicole Engel,
Hans-Peter Meinzer,
Roland Hetzer,
Felix Berger,
Titus Kuehne
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ABSTRACT: Detailed 3-dimensional anatomic information is essential when planning strategies of surgical treatment for patients with complex congenitally malformed hearts. Current imaging techniques, however, do not always provide all the necessary anatomic information in a user-friendly fashion. We sought to assess the practical clinical value of realistic 3-dimensional models of complex congenitally malformed hearts.
In 11 patients, aged from 0.8 to 27 years, all with complex congenitally malformed hearts, an unequivocal decision regarding the optimum surgical strategy had not been reached when using standard diagnostic tools. Therefore, we constructed 3-dimensional virtual computer and printed cast models of the heart on the basis of high-resolution whole-heart or cine magnetic resonance imaging or computed tomography. Anatomic descriptions were compared with intraoperative findings when surgery was performed.
Independently of age-related factors, images acquired in all patients using magnetic resonance imaging and computed tomography proved to be of sufficient quality for producing the models without major differences in the postprocessing and revealing the anatomy in an unequivocal 3-dimensional context. Examination of the models provided invaluable additional information that supported the surgical decision-making. The anatomy as shown in the models was confirmed during surgery. Biventricular corrective surgery was achieved in 5 patients, palliative surgery was achieved in 3 patients, and lack of suitable surgical options was confirmed in the remaining 3 patients.
Realistic 3-dimensional modeling of the heart provides a new means for the assessment of complex intracardiac anatomy. We expect this method to change current diagnostic approaches and facilitate preoperative planning.
The Journal of thoracic and cardiovascular surgery 10/2009; 138(3):571-80. · 3.41 Impact Factor
