3D Models Augment Surgical Decision Making in 200% Double Outlet Right Ventricle with Two Adequate Sized Ventricles
shuhua luo, Shi-Joon Yoo, Andreea Dragalescu, Christopher Caldarone, Osami Honjo, Glen Van Arsdell.
Hospital for Sick Children, Toronto, ON, Canada.
We hypothesized that the decision for BiV repair in 200% DORV would be best guided by the visualization principles of being able to create a post repair condition of: no inlet or outlet obstruction to the ventricles, adequate residual RV volume, and adequate tricuspid valve function.
Forty consecutive patients (’00-’17) having 200% DORV and adequate sized ventricles were reviewed. Preoperative echocardiographic(echo) factors reported in the literature for SV vs BiV repair were compared with our approach of clinical decisions reached by using intra operative cardiac exploration and in more recent and complicated decisions, with preoperative planning using 3D printed models (n=13) and using the 3 visualization principles.
Thirty-three patients(82.5%) had BiV repair, There was no death at a mean follow up of 60.9 (43.2-79.6) months. In all 13 3D model cases, cardiac exploration correlated with the preoperative spatial findings and planned operation. In our cohort 21 patients met echo criteria for a SV repair,5 patients received SV repair yielding an echo clinical sensitivity to predict SV repair of 71.4%. For the remaining 19 echo predicted BiV patients, 17 achieved a 2 ventricle repair, giving a specificity 51.5%.
Echo criteria alone do not adequately predict the ability to safely achieve a BiV repair for 200%
DORV. 3D printed models fully reflect spatial relationships allowing for preoperative intraventricular tunnel planning but lack valve function data. Echo augmented with 3D printed models is useful for determining feasibility of BiV repair based on the principles outlined.
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