Commentary: The road map for collaterals-A scenic route from the Abbey Road to the operating theater?

Abstract

Central MessageA 3-dimensional interactive imaging reconstruction can be helpful in patients with pulmonary atresia and major aortopulmonary collateral arteries.See Article page 82. A 3-dimensional interactive imaging reconstruction can be helpful in patients with pulmonary atresia and major aortopulmonary collateral arteries. See Article page 82. In the early 1960s, the Beatles had their first recording session with Electric and Musical Industries (EMI) at the Abbey Road Studios (formerly EMI Recording Studios). Their momentous rise in popularity changed the face of modern music at the time. It has since been surmised—albeit unverified—that this led to one of the biggest radiologic advanced in modern medicine. In the late 1960s, Godfrey Hounsfield, an electrical and computer engineer with no formal qualifications working for a scientific arm of the profitable EMI, began experimenting on whether images could be produced with differential x-ray attenuation values, leading ultimately to the first computed tomography (CT, initially known as computer axial tomography, or CAT) scan.1Sheedy II, P. Stephens D. Hattery R. Muhm J. Hartman G. Computed tomography of the body: initial clinical trial with the EMI prototype.Am J Roentgen. 1976; 127: 23-51Crossref PubMed Scopus (76) Google Scholar,2Goodman L.R. The Beatles, the Nobel Prize, and CT scanning of the chest.Thorac Surg Clin. 2010; 20: 1-7Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar It was in 1967 that the first experimental CT scan (of a mouse) was done, which took 9 days to complete.3Ambrose J. Computerized transverse axial scanning (tomography). 2. Clinical application.Br J Radiol. 1973; 46: 1023-1047Crossref PubMed Scopus (503) Google Scholar Unbeknownst to Hounsfield, Allan Cormack, a particle physicist, had also shown that multiple measures of x-ray attenuation around a target enable one to compute an image of that target. Both Cormack and Hounsfield received the Nobel Prize in Physics and Medicine in 1979. Since its humble beginnings of 4 minutes per slice and 7 minutes per reconstruction,3Ambrose J. Computerized transverse axial scanning (tomography). 2. Clinical application.Br J Radiol. 1973; 46: 1023-1047Crossref PubMed Scopus (503) Google Scholar CT scanning has evolved to a rapid diagnostic and investigative tool for physicians and surgeons alike. With such disparate uses as diagnosing an acute abdomen in the emergency department or in staging pulmonary malignancies, CT has revolutionized many areas of medicine and is continuing to do so. In the current issue of the Journal, Ghosh and colleagues4Ghosh R.M. Silvestro E. O’Byrne M.L. Whitehead K.K. A road-map for collaterals: use of 3-dimensional techniques in tetralogy of Fallot pulmonary atresia with major aortopulmonary collateral arteries.J Thorac Cardiovasc Surg Tech. 2020; 1: 82-85Scopus (2) Google Scholar have adopted CT angiography with digital 3-dimensional reconstruction for detailed and accurate assessment of the major aortopulmonary collateral arteries (MAPCAs) in patients with tetralogy of Fallot with pulmonary atresia. MAPCAs are often tortuous and complex, which may limit such traditional imaging modalities as echocardiography and angiography. The 3-dimensional reconstruction allows an interactive and comprehensive assessment of each patient's anatomy. This would certainly benefit surgical planning. Additional 3-dimensional imaging in the interactive format could be helpful, particularly for those patients in whom the ratio of native branch pulmonary arteries to MAPCAs would sway decision making from “Let It Be” to “Come Together.”5d’Udekem Y. Alphonso N. Nørgaard M.A. Cochrane A.D. Grigg L.E. Wilkinson J.L. et al.Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits.J Thorac Cardiovasc Surg. 2005; 130: 1496-1502Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar,6Ishibashi N. Shin’oka T. Ishiyama M. Sakamoto T. Kurosawa H. Clinical results of staged repair with complete unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.Eur J Cardiothorac Surg. 2007; 32: 202-208Crossref PubMed Scopus (41) Google Scholar It has been a long journey from the Abbey Road to the cardiac operating theater for CT imaging. Just when it seems that CT imaging reached the limits of its usefulness, a new scenic interactive modality appears. A road map for collaterals: Use of 3-dimensional techniques in tetralogy of Fallot pulmonary atresia with major aortopulmonary collateral arteriesJTCVS TechniquesVol. 1PreviewTreatment of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (MAPCA) remains challenging.1,2 Surgical repair involves unifocalization and arterioplasty of collaterals and frequently diminutive pulmonary arteries (PAs).2 These vessels are frequently torturous and complex, limiting the utility of traditional imaging modalities (eg, echocardiography and angiography).3 We present images from a novel visualization strategy to enhance preoperative understanding of the anatomy. Full-Text PDF Open Access