Page 58 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
120
Background: Three-dimensional (3D) modeling can be used to transform cross-sectional imaging studies into physical models. The applications for these models are growing rapidly in treatment of congenital heart disease, such as surgical planning in the setting of complex cardiac anatomy. 3D Rotational angiography (3DRA) datasets are not routinely used for 3D printing, but the superior spatial resolution of these images makes them ideal for creat- ing high-quality 3D models that include not just vascular structures but also their relationship with the airway. Our aim was to create and validate 3D heart models from 3DRA datasets in children with congenital heart disease.
Methods: 3DRA were performed, when clinically indi- cated, in children undergoing cardiac catheterization at Children’s Hospital of Colorado using a Philips Azurion System between January-April 2019.3DRA datasets were exported in DICOM format from the XtraVision workstation. The 3DRA datasets were imported into Materialise Mimics inPrint 3.0. Stereolithography files (STL) were created and post-processed for printing.The STL files were printed using either a Stratasys Connex3 Objet 260, Stratasys J750 or Dynamism Ultimaker S5 printers.For quality assur- ance,the internal lumen of printed models was coated with Isovue contrast ,placed under fluoroscopic imaging and 3DRA was performed.Five key areas of interest were mea- sured in the original and the model’s 3DRA, measurements were also obtained using XperCT function in the XtraVision workstation;using a multi-slice 3D view of the vascular structures and the airway; and were compared using linear correlation and t-tests.
Results: Over a 4-month period, eight children (age 30 days-13 years) had a 3DRA that was used to create a 3D model; five models had airway and vascular structures seg- mented and printed. These included patients with: severe proximal right pulmonary artery stenosis, single ventricle patient status-post Fontan palliation, tetralogy of Fallot (TOF) and multiple aorto-pulmonary collaterals, and sta- tus-post Glenn operation both pre- and post-left pulmo- nary artery stent placement.In two cases, only vascular structures were segmented: patient with TOF and anom- alous right coronary artery and patient with aortic arch re-coarctation. Measurements from the original and the 3D models’ 3DRA showed excellent correlation (R2=0.99, p<0.05).There was no statistical difference between both 3DRA measurements (paired t-test:p=0.02).The mean dif- ference between the original and the model's 3DRA was 0.1±0.4mm.The segmentation time was 30-90 minutes. The printing time ranged from 3-8 hours/model. Using XperCT, the relationship of the airway and the blood ves- sels was measured with no statistical difference between
the airway/blood vessel relationship of the original and the 3D model's 3DRA (paired t test:p=0.11).
Conclusions: Using 3DRA datasets, we created a novel workflow for segmenting and printing 3D models in patients with complex congenital heart disease not just including vascular structures but also airway. We validated this approach by comparison of patient and model 3DRA datasets, demonstrating excellent correlation. 3DRA has been proven useful for diagnostic purposes, procedural guidance with overlay in live fluoroscopy and now for printing 3D models with quick turnaround to enhance sur- gical and interventional planning.
76. COMPARISON OF POST-OPERATIVE COURSE OF TETRALOGY OF FALLOT PATIENTS WITH AND WITH- OUT EARLY RIGHT VENTRICULAR OUTFLOW TRACT (RVOT) BALLOONING
Caitlin Heyden1, Jane Cerise2, David Meyer1, Shilpi Epstein1
1Cohen Children’s Medical Center of New York, New Hyde Park, USA. 2Feinstein Institute for Medical Research, Manhasset, USA
Background: Tetralogy of Fallot (TOF) is the commonest cyanotic congenital heart disease with a continuum of severity depending on the degree of pulmonary outflow obstruction. Controversy exists still regarding the man- agement of cyanotic patients in early infancy; specifically, a staged approach versus full repair at an earlier age. The sub-group of TOF patients with early cyanosis (higher mor- bidity and mortality) in whom single stage repair carries high risk, would benefit from planned delay. Studies have shown transcatheter pulmonary balloon dilation in the right ventricular outflow tract (RVOT) is an effective non surgical means of early palliation.
Objective: We investigated the post-operative course in TOF patients after full repair that underwent palliative RVOT intervention for early cyanosis (a higher risk group) with those that had no prior intervention and a saturation > 85%. We hypothesize that the RVOT palliated patients did as well as lower risk patients in the early post-operative period.
Methods: A retrospective chart review of all patients who underwent full repair for tetralogy of Fallot from 1/2013- 3/2018 was done. All patients with TOF who underwent single stage surgical repair <1 year old with pulmonary valve present and functional at birth were included. Primary outcomes included duration of mechanical ven- tilation, junctional ectopic tachycardia (JET) and length of stay (LOS). Secondary outcomes included a variety of
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205