A Systematic Three-Dimensional Echocardiographic Approach to Assist Surgical Planning in Double Outlet Right Ventricle

2012 ◽  
Vol 30 (2) ◽  
pp. 234-238 ◽  
Author(s):  
Kuberan Pushparajah ◽  
Anna Barlow ◽  
Vi-Hue Tran ◽  
Owen I. Miller ◽  
Vita Zidere ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Surgical Planning ◽  
Three Dimensional ◽  
Double Outlet Right Ventricle

scholarly journals Is combined MDCT and echocardiography needed to guarantee accuracy in diagnosis and surgical planning of DORV and associated anomalies?

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Samira Saraya ◽  
Yousra Mahmoud Ahmad ◽  
Ragab Hani Donkol ◽  
Hazem Hamed Soliman ◽  
Reem Ibrahim Ismail ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Diagnostic Accuracy ◽  
Surgical Planning ◽  
Septal Defect ◽  
Preoperative Assessment ◽  
Double Outlet Right Ventricle ◽  
Great Vessels ◽  
Associated Malformations

Abstract Background The term of Double-outlet right ventricle (DORV) is used to describe a spectrum of complex congenital cardiac malformations where anomalies of the ventriculo-arterial alignment are noted where both great arteries (pulmonary artery and aorta) originate completely or predominantly from the right ventricle. The purpose of this study is to evaluate the diagnostic accuracy of electrocardiography (ECG) gated multidetector computed tomography (MDCT) in preoperative assessment of DORV and its associated malformations, providing key anatomic parameters that affect surgical planning. Results A total of 50 patients diagnosed by echocardiography with DORV referred from our institute between September 2018 and August 2020 were enrolled. The location of the ventricular septal defect (VSD) to the great vessels and the alignment of the great vessels to each other as well as other associated malformations that affect the surgical planning were assessed by MDCT. The patients were retrospectively classified into subgroups according to the relative positions of the great arteries, the relationship between the great arteries and the VSD, and the presence of associated malformations according to the classification of Society of Thoracic Surgeons database. The diagnostic value of MDCT and transthoracic echocardiography (TTE) in evaluation of associated cardiac malformations apart from double outlet right ventricle was compared in 20 patients, whom surgeries were performed and surgical results were obtained. Fallot type of DORV was the most common clinical type which represented 48% of the patients in which the VSD is committed to the aorta. The second most common clinical type was Taussig–Bing anomaly which represented 30% of the patients and the VSD was seen committed to the pulmonary artery. The atrio-ventricular septal defect (AVSD)/uni-ventricular type represented 16% of the patients in the current study, with pulmonary and systemic venous anomalies, heterotaxy syndrome and situs anomalies were commonly associated. A total of 53 malformations apart from DORV were found in 20 patients whom performed surgical interventions. MDCT detected different vascular and situs anomalies in those patients with 100% sensitivity and 100% positive predictive value compared to 71.4% and 94% respectively in TTE. On the other hand, in our study TTE was superior to MDCT for detection of intracardiac anomalies with 100% sensitivity and 100% accuracy compared to 87.5% and 95% respectively in MDCT. Conclusions Our study suggested that ECG gated MDCT serves as a rapid, noninvasive imaging modality with good spatial resolution and provides excellent diagnostic image quality and has satisfactory diagnostic accuracy in the preoperative assessment of DORV. It is superior to echocardiography in providing a comprehensive mapping of the anatomy of complex anomalies especially that of extra-cardiac structures such as aorta, systemic veins, pulmonary veins, and pulmonary arteries. However, it can miss tiny intracardiac malformations. So combining the results of MDCT and echocardiography would be beneficial to guarantee the accuracy of diagnosis of DORV.

Double-outlet right ventricle

2018 ◽  
pp. 560-565
Author(s):  
Shi-Joon Yoo ◽  
Willem A Helbing
Keyword(s):  
Blood Flow ◽  
Right Ventricle ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Preoperative Assessment ◽  
Quantitative Information ◽  
Double Outlet Right Ventricle ◽  
Surgical Anatomy ◽  
Ventricular Volumes ◽  
The Right

Double-outlet right ventricle (DORV) encompasses a wide variety of abnormalities and requires precise demonstration of the cardiovascular abnormalities using a segmental approach for surgical decision and planning. The most important is whether the left ventricle can be directed surgically to the aorta without obstruction of the pulmonary outflow tract of the right ventricle. Echocardiography is the baseline imaging modality in preoperative assessment of DORV. In complex cases, cardiovascular magnetic resonance (CMR) provides comprehensive information regarding important surgical anatomy, blood flow, and ventricular volumes. Three-dimensional (3D) angiograms and 3D print models may provide undisputable information regarding surgical anatomy and allows practice surgery on the models prior to actual surgery. DORV is frequently associated with post-operative residual findings that require reintervention. CMR is particularly useful in post-operative assessment, as it provides accurate quantitative information regarding ventricular volumes and blood flow for decision and timing of surgical or interventional procedures.

scholarly journals Transthoracic three-dimensional echocardiography for the assessment of straddling tricuspid or mitral valves

2000 ◽  
Vol 10 (6) ◽  
pp. 603-609 ◽  
Author(s):  
Michael Vogel ◽  
Siew Yen Ho ◽  
Christopher Lincoln ◽  
Robert H. Anderson
Keyword(s):  
Right Ventricle ◽  
Three Dimensional ◽  
Double Outlet Right Ventricle ◽  
Left Ventricular ◽  
3D Echocardiography ◽  
Ventricular Septum ◽  
Left Ventricular Volumes ◽  
Cross Sectional ◽  
Atrioventricular Valves ◽  
Atrioventricular Junction

AbstractBackgroundThe advent of 3D echocardiography has provided a technique which, potentially, could afford significant additional information over conventional cross-sectional echocardiography in the assessment of patients with straddling atrioventricular valves prior to surgical correction.MethodsEight patients, aged from 1 month to 9˙2 years, were examined with 3D echocardiography. All but three had discordant ventriculoarterial connections or double outlet right ventricle. Data suitable for reconstruction was acquired with transthoracic scanning. Right and left ventricular volumes were calculated in the 3D dataset.Results3D echocardiography proved capable of defining the exact degree of straddling by imaging theproportion of tension apparatus attached to either side of the ventricular septum. It was able also to display the atrioventricular junction “en face”, thus permitting identification of the precise site of insertion of the muscular ventricular septum relative to the atrioventricular junction. This made it possiblefirst, to calculate the degree of valvar override, and second, to predict the location of the penetrating atrioventricular bundle. End-diastolic volume of the right ventricle in those with straddling tricuspid valves was 73 (61–83)% of normal, and, of the left ventricle in those with mitral valvar straddling 71 (40‐97)% of normal.Conclusions3D echocardiography can aid in planning the optimal surgical procedure in patients with straddling or overrriding atrioventricular valves, as it provides diagnostic information superiorto standard crosssectional techniques. It also allows for exact measurement of the volumes of the respective ventricles.

scholarly journals Three-Dimensional Printing Model in Double-Outlet Right Ventricle to Simplify Intraventricular Repair

2018 ◽  
Vol 86 (3) ◽  
pp. 200-204
Author(s):  
Ignacio Juaneda ◽  
Ernesto Juaneda ◽  
Héctor O. Díaz ◽  
Alejandro Peirone ◽  
Gabriel Massano ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Three Dimensional ◽  
Double Outlet Right Ventricle ◽  
Three Dimensional Printing ◽  
Dimensional Printing

Abstract 4562: Real-time Transthoracic Three-dimensional Echocardiography Provides Valuable Management Information in Double Outlet Right Ventricle: An Echocardiographic-surgical Correlative study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Akio Inage ◽  
Ken Takahashi ◽  
Ivan Rebeyka ◽  
David Ross ◽  
Jeffrey F Smallhorn
Keyword(s):  
Right Ventricle ◽  
Real Time ◽  
Tricuspid Valve ◽  
Three Dimensional ◽  
Double Outlet Right Ventricle ◽  
Left Ventricular ◽  
The Mean ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
Relationship Of

Objective: To assess the incremental value of real-time transthoracic three-dimensional echocardiography (RT3DE), over two-dimensional echocardiography (2DE) in determining the adequacy of the interventricular communication (IC) and surrounding structures in double outlet right ventricle (DORV). Background: The IC size which is crucial to the management of DORV is different from the “hole” closed by the surgeon. If the IC communication is too small post operative left ventricular outflow tract obstruction can occur. Methods: Twenty patients with DORV, mean age of 1.2 years (range 0 day to 8 years) and mean body weight of 7.1 kg (range 3.1 to 21.8 kg), were examined with RT3DE, as well as 2DE. Full volume RT3DE data sets were acquired in all, using either an X3–1 or X7–2 Matrix-Array transducer (Philips Medical System). Data analysis was performed using offline Philips QLabs. We measured end diastolic (ED) and end systolic (ES) area of the IC and the “hole” closed by the surgeons by RT3DE and 2DE, and adjusted them by body surface area (BSA). As well, we measured the tricuspid to aortic and tricuspid to pulmonary valve distance (TV-AV and TV-PV distance) by RT3DE and determined the relationship of the tricuspid valve to the IC. Results: Four patients had an associated muscular VSD. The mean ED and ES IC area/BSA were 7.33 ± 3.94 and 4.25 ± 1.86 cm 2 /m 2 by RT3DE and 3.41 ± 1.9 and 2.00 ± 1.29 cm 2 /m 2 by 2DE respectively. The mean ED and ES “surgical hole” area/BSA were 10.62 ± 3.94 and 6.52 ± 2.65 cm 2 /m 2 by RT3DE and 5.90 ± 2.47 and 4.27 ± 1.36 cm 2 /m 2 by 2DE respectively. ED and ES IC and “surgical hole” areas were significantly different between RT3DE and 2DE (P value ranges: 0.024 to < 0.001). 2DE tended to underestimate IC and the “surgical hole” size. The TV-AV and TV-PV distance relationship by RT3DE could be determined and was consistent with current surgical practice for DORV. The precise relationship of tricuspid valve attachments in the vicinity of the IC were readily determined by RT3DE, but not by 2DE. Conclusion: RT3DE provides useful and additive information, and offers simulated intraoperative visualization of true IC and the “surgical hole” in DORV as well as the surrounding structures.

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