title: Three-Dimensional Reconstruction of Intracardiac Anatomy Using CTA and Surgical Planning for Double Outlet Right Ventricle: Early Experience at a Tertiary Care Congenital Heart Center.
abstract: BACKGROUND
  Although transthoracic echocardiography (TTE) routinely establishes the diagnosis of double outlet right ventricle (DORV), it can be suboptimal for depicting exact ventricular septal defect (VSD) position, especially with respect to the outflow tracts. Advanced imaging with computed tomography angiography (CTA) can help visualize structures and relationships not easily seen by echo. Using computer-aided design, we have the ability to create three-dimensional (3D) models of the intracardiac anatomy, which can be helpful for better depicting the overall anatomy to assist surgical planning.
  
  
  METHODS
  Patients with a diagnosis of DORV were retrospectively reviewed at our institution from October 2013 to April 2015. Patients who preoperatively underwent both TTE and CTA with 3D reconstruction of the intracardiac anatomy were included. Computed tomography angiography findings with 3D intracardiac model creation were compared to the surgical findings.
  
  
  RESULTS
  Twenty-five patients underwent surgical repair of DORV during the study period. Five patients had CTA with 3D reconstruction, in addition to the standard TTE images, and were included in the study. In all five cases, CTA with 3D reconstruction of the intracardiac anatomy accurately depicted the VSD position relative to important adjacent structures, including the outflow tracts.
  
  
  CONCLUSIONS
  Three-dimensional reconstruction of the intracardiac anatomy using CTA data can provide accurate data for presurgical planning of DORV repair and has the potential for being especially useful in patients for whom intracardiac anatomy and VSD position cannot be well seen by TTE. A larger prospective analysis is warranted to help validate this approach.
authors.affiliation: Department of Pediatric Radiology, Kosair Children's Hospital, Norton Healthcare, Louisville, KY, USA philip.dydynski@nortonhealthcare.org.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Dydynski
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Kiper
authors.affiliation: Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kozik
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY, USA Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA.
authors.forename: Bradley B
authors.initials: BB
authors.lastname: Keller
authors.affiliation: Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Erle
authors.initials: E
authors.lastname: Austin
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Holland
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004310:Double Outlet Right Ventricle / Q000000981:diagnostic imaging* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D063128:Tertiary Health Care
keywords: 3D CT; DORV; computer-aided design; myocardial modeling; surgical planning