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      Virtual Surgery for Conduit Reconstruction of the Right Ventricular Outflow Tract

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          Abstract

          Purpose

          Virtual surgery involves the planning and simulation of surgical reconstruction using three-dimensional (3D) modeling based upon individual patient data, augmented by simulation of planned surgical alterations including implantation of devices or grafts. Here we describe a case in which virtual cardiac surgery aided us in determining the optimal conduit size to use for the reconstruction of the right ventricular outflow tract.

          Description

          The patient is a young adolescent male with a history of tetralogy of Fallot with pulmonary atresia, requiring right ventricle-to-pulmonary artery (RV-PA) conduit replacement. Utilizing preoperative magnetic resonance imaging data, virtual surgery was undertaken to construct his heart in 3D and to simulate the implantation of three different sizes of RV-PA conduit (18, 20, and 22 mm).

          Evaluation

          Virtual cardiac surgery allowed us to predict the ability to implant a conduit of a size that would likely remain adequate in the face of continued somatic growth and also allow for the possibility of transcatheter pulmonary valve implantation at some time in the future. Subsequently, the patient underwent uneventful conduit change surgery with implantation of a 22-mm Hancock valved conduit. As predicted, the intra-thoracic space was sufficient to accommodate the relatively large conduit size without geometric distortion or sternal compression.

          Conclusion

          Virtual cardiac surgery gives surgeons the ability to simulate the implantation of prostheses of different sizes in relation to the dimensions of a specific patient’s own heart and thoracic cavity in 3D prior to surgery. This can be very helpful in predicting optimal conduit size, determining appropriate timing of surgery, and patient education.

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          Author and article information

          Journal
          101518415
          39838
          World J Pediatr Congenit Heart Surg
          World J Pediatr Congenit Heart Surg
          World journal for pediatric & congenital heart surgery
          2150-1351
          2150-136X
          14 November 2017
          May 2017
          20 November 2017
          : 8
          : 3
          : 391-393
          Affiliations
          [1 ]Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
          [2 ]Division of Cardiology, Children’s National Health System, Washington DC, USA
          [3 ]Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, USA
          Author notes
          Corresponding Author: Narutoshi Hibino, Division of Cardiac Surgery, The Johns Hopkins Hospital, Suite 7107, Sheikh Zayed Tower, 1800 Orleans St, Baltimore, MD 21287, USA. nhibino1@ 123456jhmi.edu
          Article
          PMC5695863 PMC5695863 5695863 nihpa919787
          10.1177/2150135117692777
          5695863
          28520540

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