JACC: CARDIOVASCULAR IMAGING
VOL. 8, NO. 1, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-878X/$36.00
PUBLISHED BY ELSEVIER INC.
LETTERS TO THE EDITOR
tomography (CT) imaging coupled with 3-dimensional (3D) printing may allow better visualization of anatomy and improve planning. TOF with PA was pre-
A Novel Approach to Neonatal Management
natally diagnosed (Figure 1A). Cardiac CT scanning
of Tetralogy of Fallot, With Pulmonary Atresia,
with a minimal radiation protocol at 1 day of age
and Multiple Aortopulmonary Collaterals
revealed dual pulmonary blood supply (Figures 1B and 1C). The true pulmonary arteries were hypoplastic and confluent and appeared distributed to all
Tetralogy of Fallot (TOF), pulmonary atresia (PA), and
major lung segments. Three-dimensional CT recon-
multiple aortopulmonary collateral arteries (MAPCAs)
struction and 3D printing (Figure 1D) were performed
need complex interventions, and pre-natal diagnosis
to illustrate the anatomic location of the aorto-
allows for appropriate peri-partum planning (1).
pulmonary collaterals. The imaging and 3D print
Traditionally the post-natal echocardiogram is fol-
(available in the operative suite) were used to guide
lowed by cardiac catheterization to identify the
successful placement of a large central aortopulmo-
MAPCA anatomy (2). We found that computed
nary shunt and used as a map for subsequent coiling
F I G U R E 1 Example of Pre-Interventional Planning Using 3D Printed Models
Transthoracic echocardiogram (A) confirms tetralogy of Fallot/pulmonary atresia/multiple aortopulmonary collateral arteries (MAPCAs) diagnosis. Three-dimensional (3D) reconstruction (B and C) illustrates spatial relationship of patient-specific geometry such as true pulmonary arteries (blue), aorta (red), and MAPCAs (green and yellow) for central aortopulmonary shunt placement and coil planning. Three-dimensional printing (D) provides absolute scaling for planning purposes, as well as patient/family education. Angiography (E and F) captured after central shunt and prior to placement of MAPCA embolization coils.
104
JACC: CARDIOVASCULAR IMAGING, VOL. 8, NO. 1, 2015
Letters to the Editor
JANUARY 2015:103–10
of redundant collateral vessels. No pre-operative
Mechanical Dispersion by Strain
cardiac
Echocardiography: A Predictor of
catheterization
was
performed.
The
3D
print model was available in the cardiac catheteri-
Ventricular Arrhythmias in Subjects With
zation laboratory during percutaneous coiling of 2 of
Lamin A/C Mutations
3 known aortopulmonary collaterals. The third was found to be atretic as shown in Figures 1E and 1F. This process helped focus catheter-based interven-
Sudden death is the first symptom of heart disease
tion and reduced the amount of fluoroscopy time
in many patients. Prevention of sudden death
and contrast exposure. The central shunt remains in
must therefore be achieved by screening groups of
place to promote growth of confluent native pul-
high-risk individuals and offering an implantable
monary arteries. The patient is awaiting complete
cardioverter-defibrillator (ICD) as the primary pre-
repair. Historically, CT angiography has been used
vention therapy in selected individuals. Selecting
infrequently because it does not measure hemody-
patients for primary ICD therapy remains chal-
namics or provide images with high enough re-
lenging. Patients with mutations in the lamin A/C
solution to allow for pre-operative planning (3).
gene (LMNA) constitute a small but important part
However, as seen in Figure 1, 3D printing of CT
(5% to 8%) of those with familial dilated cardiomy-
datasets may provide significant advantages in
opathy. The cardiac phenotype is malignant and
pre-operative and pre-procedural planning. This
characterized by atrioventricular block, as well
method can allow for reductions in general anes-
as supraventricular and ventricular arrhythmias,
thesia exposure, fluoroscopy time, and cardiopulmo-
which often precede cardiac dilation (1). General ICD
nary by pass time. Three-dimensional prints can also
guidelines for dilated cardiomyopathy patients, rec-
be used as didactic tools to help educate parents and
ommending primary prevention ICD at ejection
patients about patient-specific cardiac anatomy and
fraction (EF)
VOL. 8, NO. 1, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-878X/$36.00
PUBLISHED BY ELSEVIER INC.
LETTERS TO THE EDITOR
tomography (CT) imaging coupled with 3-dimensional (3D) printing may allow better visualization of anatomy and improve planning. TOF with PA was pre-
A Novel Approach to Neonatal Management
natally diagnosed (Figure 1A). Cardiac CT scanning
of Tetralogy of Fallot, With Pulmonary Atresia,
with a minimal radiation protocol at 1 day of age
and Multiple Aortopulmonary Collaterals
revealed dual pulmonary blood supply (Figures 1B and 1C). The true pulmonary arteries were hypoplastic and confluent and appeared distributed to all
Tetralogy of Fallot (TOF), pulmonary atresia (PA), and
major lung segments. Three-dimensional CT recon-
multiple aortopulmonary collateral arteries (MAPCAs)
struction and 3D printing (Figure 1D) were performed
need complex interventions, and pre-natal diagnosis
to illustrate the anatomic location of the aorto-
allows for appropriate peri-partum planning (1).
pulmonary collaterals. The imaging and 3D print
Traditionally the post-natal echocardiogram is fol-
(available in the operative suite) were used to guide
lowed by cardiac catheterization to identify the
successful placement of a large central aortopulmo-
MAPCA anatomy (2). We found that computed
nary shunt and used as a map for subsequent coiling
F I G U R E 1 Example of Pre-Interventional Planning Using 3D Printed Models
Transthoracic echocardiogram (A) confirms tetralogy of Fallot/pulmonary atresia/multiple aortopulmonary collateral arteries (MAPCAs) diagnosis. Three-dimensional (3D) reconstruction (B and C) illustrates spatial relationship of patient-specific geometry such as true pulmonary arteries (blue), aorta (red), and MAPCAs (green and yellow) for central aortopulmonary shunt placement and coil planning. Three-dimensional printing (D) provides absolute scaling for planning purposes, as well as patient/family education. Angiography (E and F) captured after central shunt and prior to placement of MAPCA embolization coils.
104
JACC: CARDIOVASCULAR IMAGING, VOL. 8, NO. 1, 2015
Letters to the Editor
JANUARY 2015:103–10
of redundant collateral vessels. No pre-operative
Mechanical Dispersion by Strain
cardiac
Echocardiography: A Predictor of
catheterization
was
performed.
The
3D
print model was available in the cardiac catheteri-
Ventricular Arrhythmias in Subjects With
zation laboratory during percutaneous coiling of 2 of
Lamin A/C Mutations
3 known aortopulmonary collaterals. The third was found to be atretic as shown in Figures 1E and 1F. This process helped focus catheter-based interven-
Sudden death is the first symptom of heart disease
tion and reduced the amount of fluoroscopy time
in many patients. Prevention of sudden death
and contrast exposure. The central shunt remains in
must therefore be achieved by screening groups of
place to promote growth of confluent native pul-
high-risk individuals and offering an implantable
monary arteries. The patient is awaiting complete
cardioverter-defibrillator (ICD) as the primary pre-
repair. Historically, CT angiography has been used
vention therapy in selected individuals. Selecting
infrequently because it does not measure hemody-
patients for primary ICD therapy remains chal-
namics or provide images with high enough re-
lenging. Patients with mutations in the lamin A/C
solution to allow for pre-operative planning (3).
gene (LMNA) constitute a small but important part
However, as seen in Figure 1, 3D printing of CT
(5% to 8%) of those with familial dilated cardiomy-
datasets may provide significant advantages in
opathy. The cardiac phenotype is malignant and
pre-operative and pre-procedural planning. This
characterized by atrioventricular block, as well
method can allow for reductions in general anes-
as supraventricular and ventricular arrhythmias,
thesia exposure, fluoroscopy time, and cardiopulmo-
which often precede cardiac dilation (1). General ICD
nary by pass time. Three-dimensional prints can also
guidelines for dilated cardiomyopathy patients, rec-
be used as didactic tools to help educate parents and
ommending primary prevention ICD at ejection
patients about patient-specific cardiac anatomy and
fraction (EF)
