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(Circulation. 2007;115:e312.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Virtual Cardiotomy for Preoperative Planning

Thomas Sangild Sørensen, PhD; Jesper Mosegaard, PhD; Gerald Franz Greil, MD; Stephan Miller, MD; Achim Seeger, MD; Ole Kromann Hansen, MD; Ludger Sieverding, MD

From the Centre for Advanced Visualisation and Interaction (T.S.S.) and the Department of Computer Science (J.M.), University of Aarhus, Aarhus, Denmark; Departments of Cardiology (G.F.G., L.S.) and Radiology (S.M., A.S.), Tübingen University Hospital, Tübingen, Germany; and Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (O.K.H.).

Correspondence to Thomas Sangild Sørensen, CAVI/University of Aarhus, Aabogade 34, 8200 Aarhus N, Denmark. E-mail sangild{at}cavi.dk

A 2-month-old boy with double-outlet right ventricle was referred for magnetic resonance imaging to describe the exact spatial relations of the intracardiac morphology. The infundibular septum strongly deviated to the right, and a large ventricular septal defect starting at the subpulmonary level, crossing the infundibular septum, and ending at the subaortic level was present; the heart thus resembled a Taussig–Bing heart.¹ For surgical correction of Taussig–Bing hearts, an arterial switch is the first-line option. Unfortunately, the anatomy of the coronary arteries was found as a single coronary artery with intramural course of the right coronary artery, making the switch of the coronary arteries from native aorta to neoaorta very difficult. Hence, the possibility of an intraventricular correction is of high interest.

We recently developed a virtual incision–making tool that allows arbitrary incisions to be made in a 3-dimensional reconstruction of the magnetic resonance imaging data.² The Figure shows 2 such incisions: 1 subaortic, the other at the main pulmonary artery. Through these incisions, the intracardiac morphology can be inspected from any desired view. Although not yet proven, it is our belief that such reconstructions, combined with virtual cardiotomy and appropriate virtual excisions, could be a valuable new approach for preoperative assessment of potential surgical strategies, once the coronary anatomy is implemented. The Data Supplement Movie shows the interactive placement of incisions. These incisions give evidence that intraventricular rerouting will be difficult.

View larger version (45K): [in this window] [in a new window]   Virtual reconstruction with incisions at the aortic root (AO, left) and the main pulmonary artery (MPA, right) reveals the exact course of a large ventricular septal defect (VSD). IVC indicates inferior vena cava; SVC, superior vena cava; RA, right atrium; RV, right ventricle; and LV, left ventricle.

	Acknowledgments

 
The authors received funding from the Danish Research Council, the Danish Heart Foundation, and the Stiftung zur Förderung der Erforschung der Zivilisationserkrankungen, Germany.

Disclosures

None.

	Footnotes

 
The online-only Data Supplement, consisting of a movie, is available with this article at http://circ.ahajournals.org/cgi/ content/full/115/9/e312/DC1.

	References

Top References

 
1. van Praagh R. What is the Taussig-Bing malformation? Circulation. 1968; 38: 445–449.[Free Full Text]

2. Sørensen TS, Greil GF, Hansen OK, Mosegaard J. Surgical simulation—a new tool to evaluate surgical incisions in congenital heart disease? Interactive Cardiovasc Thorac Surg. 2006; 5: 536–539.[Abstract/Free Full Text]

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This Article Extract Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sørensen, T. S. Articles by Sieverding, L. Search for Related Content PubMed PubMed Citation Articles by Sørensen, T. S. Articles by Sieverding, L. Related Collections CT and MRI Pediatric and congenital heart disease, including cardiovascular surgery Related Article