Perry S Choi1, Hannah H Nam2, Andras Lasso3, Christian Herz2, Simon Drouin4, David M Harrild5, Michael Quartermain6, Gabor Fichtinger3, Christopher E Mascio7, Sitaram Emani1, Matthew A Jolley8. 1. Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Queen's University, Kingston, Ontario, Canada. 4. Brigham and Women's Hospital, Boston, Massachusetts. 5. Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 6. Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Division of Pediatric Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 8. Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: jolleym@email.chop.edu.
Abstract
PURPOSE: In children with a mitral annulus too small to accommodate traditional prostheses, surgical implantation of stent-based valves is a promising option. However no reliable preoperative methods exist to guide patient selection, device sizing, and positioning. We describe a novel methodology to visualize and quantify device fit in 3-dimensional echocardiogram (3DE)-derived heart models. DESCRIPTION: Heart models were created from existing preoperative 3DEs using custom software. Valve models were virtually implanted into the models, and both device fit and left ventricular outflow tract (LVOT) area were quantified. EVALUATION: The 3DEs of 3 patients who underwent Melody valve placement in the mitral position were retrospectively modeled: 1 with LVOT obstruction, 1 with perivalvar leak, and 1 without complications. In all cases 2-dimensional measurements underestimated 3D annular dimensions, and the patient with clinical LVOT obstruction had the lowest predicted LVOT area-to-aortic area ratio (0.5). CONCLUSIONS: 3DE-based preoperative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOT obstruction.
PURPOSE: In children with a mitral annulus too small to accommodate traditional prostheses, surgical implantation of stent-based valves is a promising option. However no reliable preoperative methods exist to guide patient selection, device sizing, and positioning. We describe a novel methodology to visualize and quantify device fit in 3-dimensional echocardiogram (3DE)-derived heart models. DESCRIPTION: Heart models were created from existing preoperative 3DEs using custom software. Valve models were virtually implanted into the models, and both device fit and left ventricular outflow tract (LVOT) area were quantified. EVALUATION: The 3DEs of 3 patients who underwent Melody valve placement in the mitral position were retrospectively modeled: 1 with LVOT obstruction, 1 with perivalvar leak, and 1 without complications. In all cases 2-dimensional measurements underestimated 3D annular dimensions, and the patient with clinical LVOT obstruction had the lowest predicted LVOT area-to-aortic area ratio (0.5). CONCLUSIONS: 3DE-based preoperative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOT obstruction.
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Authors: Andras Lasso; Christian Herz; Hannah Nam; Alana Cianciulli; Steve Pieper; Simon Drouin; Csaba Pinter; Samuelle St-Onge; Chad Vigil; Stephen Ching; Kyle Sunderland; Gabor Fichtinger; Ron Kikinis; Matthew A Jolley Journal: Front Cardiovasc Med Date: 2022-09-06