20 Multimodality 4D imaging and modelling for complex double outlet right ventricles

Abstract

Double outlet right ventricle can have multilevel complexity some with normal situs, levocardia and non-committed ventricular septal defect (DORV-NCVSD), and some with Dextrocardia, or abnormal situs, borderline right or left ventricles and juxtaposed atrial appendages. Decision-making can be extremely difficult due to the complex 3-dimensional spatial relationships of the atrial communication, the ventricular septal defect (VSD), the semilunar valves and the atrioventricular valves; along with the size of the ventricular cavities. Understanding of these relationships can determine whether the patient is suitable for a biventricular repair or not. Recently, advances in 3D printing have been made allowing models to be made from cross-sectional imaging (usually CT or MRI images). These can be very useful; however, they are still subject to the limitations of the chosen imaging modality. We present a case series of 4 cases of complex DORVs; 2 with NCVSD, and 2 with Dextrocardia borderline ventricles and Juxtaposed atrial appendages where we used a combination of 4D echocardiographic, CT and angiographic information fed into the materialise software to create as detailed as possible picture of all the anatomic features. This enabled detailed surgical plans to be made. Anatomical details at the time of surgery were entirely consistent with the information given by all of the various imaging modalities, allowing confidence in the planning process. Conclusion These cases demonstrate the value of using a variety of imaging modalities for complex DORV cases, ensuring that important details are not missed.