The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 571-580, September 2009

The practical clinical value of three-dimensional models of complex congenitally malformed hearts

  • Eugénie Riesenkampff, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
    • E.R. and U.R. contributed equally to this article.
    • Corresponding Author InformationAddress for reprints: Eugénie Riesenkampff, MD, Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, D-13353 Berlin, Germany.
    • ,
  • Urte Rietdorf, MSc

      Affiliations

    • German Cancer Research Centre Heidelberg, Division of Medical and Biological Informatics, Heidelberg, Germany
    • E.R. and U.R. contributed equally to this article.
    • ,
  • Ivo Wolf, PhD

      Affiliations

    • German Cancer Research Centre Heidelberg, Division of Medical and Biological Informatics, Heidelberg, Germany
    • ,
  • Bernhard Schnackenburg, PhD

      Affiliations

    • Philips Medical Systems, Hamburg, Germany
    • ,
  • Peter Ewert, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
    • ,
  • Michael Huebler, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
    • ,
  • Vladimir Alexi-Meskishvili, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
    • ,
  • Robert H. Anderson, MD

      Affiliations

    • University College London, Cardiac Unit, Institute of Child Health, London, United Kingdom
    • ,
  • Nicole Engel, MD

      Affiliations

    • German Cancer Research Centre Heidelberg, Division of Medical and Biological Informatics, Heidelberg, Germany
    • ,
  • Hans-Peter Meinzer, PhD

      Affiliations

    • German Cancer Research Centre Heidelberg, Division of Medical and Biological Informatics, Heidelberg, Germany
    • ,
  • Roland Hetzer, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
    • ,
  • Felix Berger, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
    • ,
  • Titus Kuehne, MD

      Affiliations

    • Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany

Received 7 November 2008; received in revised form 14 January 2009; accepted 9 March 2009. published online 08 June 2009.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Abbreviations and Acronyms: CT, computed tomography, MRI, magnetic resonance imaging, 3D, 3 dimensional

CTSNet classification: 20, 21

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 This work was supported by the German Science Association (DFG) and the German Federal Ministry of Education and Research, grant KU1329/5-1 and 01EV0704, and by the “Fördergemeinschaft deutscher Kinderherzzentren.” Responsibility for the contents rests with the authors.

PII: S0022-5223(09)00412-7

doi:10.1016/j.jtcvs.2009.03.011

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 571-580, September 2009

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