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Intracardiac Three-Dimensional Image as Surgical Decision-Making Tool of Congenital Heart Disease

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Abstract

This study aimed to evaluate the anatomical reproducibility of a preoperative intracardiac 3D image (IC image) created using computed tomography, and to investigate its usefulness as a surgical decision-making tool. Between 2012 and 2022, ventricular septal defect (VSD) patients, and double outlet right ventricle (DORV) or transposition of the great arteries (TGA) with pulmonary stenosis (PS) patients who underwent cardiac surgery and had preoperative computed tomography were enrolled. SYNAPSE VINCENT® (Fujifilm) was used to create an IC image which was analyzed retrospectively. In 14 VSD patients, the diagnostic consistency rate in the Soto classification with intraoperative findings was 100% (14/14) for IC image versus 64% (9/14) for transthoracic echocardiography (P = 0.04). The defect size showed a higher correlation coefficient with IC image (0.837, P = 0.001) than with transthoracic echocardiography (0.567, P = 0.034). In 11 DORV/TGA with PS patients, the diagnostic consistency rate in the Lev classification was 100% (9/9) for IC image versus 77% (7/9) for transthoracic echocardiography (P = 0.47). The secondary interventricular foramen (SVF)/left ventricular outflow tract (LVOT) ratio by IC image was significantly smaller in the biventricular-repair group (median 0.71, IQR 0.67–1.06) than in the univentricular-repair group (median 1.79, IQR 1.53–2.42) (P = 0.006). An IC image is useful as a surgical decision-making tool for simple VSDs and complex congenital heart diseases such as DORV or TGA with pulmonary stenosis. The SVF/LVOT ratio determined from the IC image may be a useful indicator for avoiding LVOT obstruction.

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Data Availability

The data for this article is available upon reasonable request to the corresponding author.

Abbreviations

BSA:

Body surface area

CHD:

Congenital heart disease

CT:

Computed tomography

DORV:

Double outlet right ventricle

IC image:

Intracardiac 3D image

IQR:

Interquartile range

LVOT:

Left ventricular outflow tract

LVOTO:

Left ventricular outflow tract obstruction

MRI:

Magnetic resonance imaging

PS:

Pulmonary stenosis

SVF:

Secondary interventricular foramen

TAVR:

Transcatheter aortic valve replacement

TGA:

Transposition of the great arteries

TTE:

Transthoracic echocardiography

VSD:

Ventricular septal defect

3D:

Three dimensional

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Acknowledgements

We thank Dr. Edward Barroga (https://orcid.org/0000-0002-8920-2607 ), Medical Editor, Professor of Medical Education at Showa University School of Medicine, Japan, and Adjunct Faculty of Graduate Academic Writing at St. Luke’s International University, Japan for editing the manuscript.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Toho University Omori Medical Center, 6-11 Omori-Nishi Ota-Ku, Tokyo, 143-8541, Japan

    Sho Isobe, Yuzo Katayama, Tsukasa Ozawa & Takeshiro Fujii

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  1. Sho Isobe
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  2. Yuzo Katayama
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  3. Tsukasa Ozawa
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  4. Takeshiro Fujii
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Contributions

SI: Data curation; Formal analysis; Writing—original draft. YK: Formal analysis; Methodology; Writing—original draft; Writing—review & editing. TO: Writing—review & editing. TF: Writing—review & editing.

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Correspondence to Yuzo Katayama.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical Approval

The study was approved the Research Ethics Committee of Toho University Omori Medical Center (Approval no: M22080; Approval date: July 12, 2022). The study complies with the Declaration of Helsinki.

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An opt-out procedure was used for informed consent by posting on the hospital website.

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Isobe, S., Katayama, Y., Ozawa, T. et al. Intracardiac Three-Dimensional Image as Surgical Decision-Making Tool of Congenital Heart Disease. Pediatr Cardiol 45, 351–360 (2024). https://doi.org/10.1007/s00246-023-03349-w

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