New technology
Modeling Tool for Rapid Virtual Planning of the Intracardiac Baffle in Double-Outlet Right Ventricle

https://doi.org/10.1016/j.athoracsur.2021.02.058Get rights and content

Abstract

Purpose

Biventricular repair of double-outlet right ventricle (DORV) necessitates the creation of a complex intracardiac baffle. Creation of the optimal baffle design and placement thereof can be challenging to conceptualize, even with 2-dimensional and 3-dimensional images. This report describes a recently developed methodology for creating virtual baffles to inform intraoperative repair.

Description

A total of 3 heart models of DORV were created from cardiac magnetic resonance images. Baffles were created and visualized using custom software.

Evaluation

This report demonstrates application of the tool to virtual planning of the baffle for repair of DORV in 3 cases. Models were examined by a multidisciplinary team, on screen and in virtual reality. Baffles could be rapidly created and revised to facilitate planning of the surgical procedure.

Conclusions

Virtual modeling of the baffle pathway by using cardiac magnetic resonance, creation of physical templates for the baffle, and visualization in virtual reality are feasible and may be beneficial for preoperative planning of complex biventricular repairs in DORV. Further work is needed to demonstrate clinical benefit or improvement in outcomes.

Section snippets

Patient Selection and Image Acquisition

An existing institutional database of patients who had undergone CMR and segmentation for 3D printing for the planning of surgical repair of DORV was queried, and 3 representative studies were identified. The CMR studies had been performed on a 1.5-Tesla scanner (Magnetom Avento, Siemens Healthcare, Erlangen, Germany) by using ferumoxytol, an iron-based contrast agent. A navigated cardiac-gated inversion recovery FLASH sequence was performed to assess the vascular anatomy. The Institutional

Study Design

Baffles were created in preoperative CMR-based models of 3 patients for demonstration and exploration of planning (Figure 5, Videos 1 to 3). Patients’ demographics are shown in Table 1.

Results

The baffle planning tool allowed simpler and faster interaction and refinement of baffles within 3D models compared with segmentation-based tools historically used to design baffles in 2D views. The average baffle placement time with the new tool was 2 minutes. In addition, baffles could be easily altered and

Comment

This freely available, open-source dedicated software modeling workflow is designed for the rapid creation of baffles for the planning of biventricular repair of DORV. On the basis of our initial clinical experience, we assert 3 main findings: (1) preoperative image-based virtual modeling holds promise for improved planning of surgical repair of DORV, (2) baffle planning is faster and requires less user experience with this dedicated tool relative to segmentation and commercially available

Disclosures and Freedom of Investigation

This work was supported by a Children’s Hospital of Philadelphia (CHOP) Cardiac Center Innovation Grant, a CHOP Cardiac Center Research Grant, a CHOP Frontier Grant, National Institutes of Health grants R01 HL153166 and T32GM008562, and CANARIE’s Research Software Program. Dr Pinter is employed by Pixel Medical and served as a contracted software developer for parts of this work. All other authors declare no relevant conflicts of interest or disclosures. No commercial entity provided any direct

Disclaimer

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

References (6)

There are more references available in the full text version of this article.

Cited by (14)

View all citing articles on Scopus
View full text