Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data.
OBJECTIVE
To determine if magnetic resonance (MR) imaging data can be used to create rigid models that are accurate representations of the right ventricular outflow tract (RVOT) and pulmonary trunk anatomy and if such models can be used to refine the selection of patients for percutaneous pulmonary valve implantation (PPVI).


METHODS
Institutional review board approval and informed patient consent were obtained. Twelve patients' MR data were analyzed and elaborated for input into a rapid prototyping (RP) system. RP models were successfully built and presented to two experienced cardiologists, who were retrospectively asked if they would have attempted PPVI. Their responses were compared with the documented decisions and outcomes of PPVI.


RESULTS
For four subjects, both cardiologists correctly determined, on the basis of MR image or three-dimensional (3D) RP model findings, that PPVI should not have been attempted. Two patients in whom PPVI was attempted were considered to be unsuitable for the procedure after balloon sizing, and in another two patients, implantation was unsuccessful because of device instability. For the four patients in whom PPVI was suitable and the four in whom it was unsuitable, observers 1 and 2 correctly determined suitability for PPVI in four and two patients, respectively, by using the MR images alone. Both observers correctly determined the suitability of five patients by using the 3D models alone.


CONCLUSIONS
Using 3D RP models resulted in more accurate selection of patients for PPVI than did using MR images.
Schievano
Silvia
S
Cardiothoracic Unit, UCL Institute of Child Health & Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, England.
Migliavacca
Francesco
F
Coats
Louise
L
Khambadkone
Sachin
S
Carminati
Mario
M
Wilson
Neil
N
Deanfield
John E
JE
Bonhoeffer
Philipp
P
Taylor
Andrew M
AM
D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D002648:Child; D017076:Computer-Aided Design; D003657:Decision Making; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008953:Models, Anatomic; D010347:Patient Care Planning; D018579:Patient Selection; D019047:Phantoms, Imaging; D011651:Pulmonary Artery / Q000473:pathology*; D011664:Pulmonary Valve / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome