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