Double outlet right ventricle with anterior and left-sided aorta and subpulmonary ventricular septal defect

Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study

OBJECTIVES

In complex double outlet right ventricle (DORV) patients, the optimal surgical approach may be difficult to assess based on conventional 2-dimensional (2D) ultrasound (US) and computed tomography (CT) imaging. The aim of this study is to assess the added value of 3-dimensional (3D) printed and 3D virtual reality (3D-VR) models of the heart used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities.

METHODS

Five patients with different DORV subtypes and high-quality CT scans were selected retrospectively. 3D prints and 3D-VR models were created. Twelve congenital cardiac surgeons and paediatric cardiologists, from 3 different hospitals, were shown 2D-CT first, after which they assessed the 3D print and 3D-VR models in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures and the surgical plan.

RESULTS

Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D. The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01). The percentage of proposed surgical plans corresponding to the performed surgical approach was 66% for plans based on US/CT, 78% for plans based on 3D printing and 80% for plans based on 3D-VR visualization.

CONCLUSIONS

This study shows that both 3D printing and 3D-VR have additional value for cardiac surgeons and cardiologists over 2D imaging, because of better visualization of spatial relationships. As a result, the proposed surgical plans based on the 3D visualizations matched the actual performed surgery to a greater extent.

Double-outlet right ventricle and double septal defects in a Rhesus macaque (Macaca mulatta)

A 6-year-old male India-origin Rhesus macaque (Macaca mulatta) presented with thin body condition and muscular atrophy. Thoracic auscultation revealed a grade VI/VI pansystolic murmur bilaterally. Radiographs showed cardiomegaly with significant left atrial and biventricular enlargement, a dilated pulmonary artery, and hepatomegaly. Electrocardiogram revealed a normal sinus rhythm interspersed with ventricular bigeminy. Hematology showed mild polycythemia and prerenal azotemia. Necropsy demonstrated double-outlet right ventricle with a large subaortic ventricular septal defect, subpulmonary stenosis, small atrial septal defect, and right ventricular hypertrophy. The major histological finding was severe chronic passive hepatic congestion. Double-outlet right ventricle is a rare congenital heart disease, both in human beings and animals.