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20 Multimodality 4D imaging and modelling for complex double outlet right ventricles
  1. Greg Skinner,
  2. Saran Durairaj,
  3. Suhair O Shebani
  1. East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK


Double outlet right ventricle can have multilevel complexity some with normal situs, levocardia and non-committed ventricular septal defect (DORV-NCVSD), and some with Dextrocardia, or abnormal situs, borderline right or left ventricles and juxtaposed atrial appendages.

Decision-making can be extremely difficult due to the complex 3-dimensional spatial relationships of the atrial communication, the ventricular septal defect (VSD), the semilunar valves and the atrioventricular valves; along with the size of the ventricular cavities. Understanding of these relationships can determine whether the patient is suitable for a biventricular repair or not.

Recently, advances in 3D printing have been made allowing models to be made from cross-sectional imaging (usually CT or MRI images). These can be very useful; however, they are still subject to the limitations of the chosen imaging modality.

We present a case series of 4 cases of complex DORVs; 2 with NCVSD, and 2 with Dextrocardia borderline ventricles and Juxtaposed atrial appendages where we used a combination of 4D echocardiographic, CT and angiographic information fed into the materialise software to create as detailed as possible picture of all the anatomic features. This enabled detailed surgical plans to be made. Anatomical details at the time of surgery were entirely consistent with the information given by all of the various imaging modalities, allowing confidence in the planning process.

Conclusion These cases demonstrate the value of using a variety of imaging modalities for complex DORV cases, ensuring that important details are not missed.

Abstract 20 Figure 1

(A) Subcostal TTE image showing short axis view across the ventricles. VSD is divided by a band of tissue close to the tricuspid value. A – Aorta; B – Tricuspid valve; C – Dividing band, (B) 3D TTE showing similar view as Fig la. This allows better appreciation of the small size of the superior VSD and its relationship to the aorta, A – Aorta; B – Superior VSD; C – inferior VSD. (C) Segmented 3D model from CT scan showing the VSD and its relationship to the outflows. Beige – Atria and ventricles; Red – Aorta; BIue–PAs;A – Superior VSD; B – Dividing band;C – Inferior VSD. (D) 3D printed model from segmented CT scan. View of the RV aspect of the interventricular septum (RV free wall removed) demonstrating the divided VSD. A – Aorta; B – Superior VSD; C – Inferior VSD; D – Dividing band.

Abstract 20 Figure 2

(A) 3D TTE view from posterior aspect (posterior RV and RA walls removed) demonstrating complex atrial anatomy. A – Aorta; B – Tricuspid value; C – Ostium of left atrial appendage; D – Ostium of right atrial appendage; Red arrows – blood flow through ASD and TV. (B) Further view of atrial anatomy, seen for base of heart (posterior atrial wall removed). A – Tip of left atrial appendage; B – tip of right atrial appendage; C – ASD. (C) Segmented 3D model from 3D whole heart navigator sequence MRI scan, showing relationship of the VSD to the outflows. Posterior view with posterior wall of RV removed. Orange – ventricles; Red – Aorta; Blue PAs; A – VSD. (D) 3D printed model from 3D whole heart navigator sequence MRI scan, viewed from anterior aspect to demonstrate gross anatomy. A – Aorta; B – Left SVC / Glenn shunt; C –Right atrial appendage; D – left atrial appendage; E – LV; F – RV.

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