Stent interventions guided by three-dimensional rotational angiography to treat total cavopulmonary connection stenosis

The recent developments in imaging techniques have created new opportunities to give an accurate description of the three-dimensional morphology of vessels. Such three-dimensional reconstruction of anatomical structures from medical images has achieved importance in several applications, such as the reconstruction of human bones, spine portions, and vascular districts.

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The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00628.2008 ◽

2008 ◽

Vol 295 (6) ◽

pp. H2427-H2435 ◽

Cited By ~ 82

Author(s):

Kartik S. Sundareswaran ◽

Kerem Pekkan ◽

Lakshmi P. Dasi ◽

Kevin Whitehead ◽

Shiva Sharma ◽

...

Keyword(s):

Heart Rate ◽

Single Ventricle ◽

Fluid Dynamic ◽

Three Dimensional ◽

Lumped Parameter Model ◽

Total Cavopulmonary Connection ◽

Dynamic Simulations ◽

Lumped Parameter ◽

The Impact ◽

Cavopulmonary Connection

Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 ± 0.80 WU) and systemic vascular resistances (18.4 ± 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 ± 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI ( n = 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity = −0.064 l·min−1·WU−1) but not for the SV circulation (sensitivity = −0.88 l·min−1·WU−1). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (+35%) and decreased preload (−12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology.

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In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(00)02517-0 ◽

2001 ◽

Vol 71 (3) ◽

pp. 889-898 ◽

Cited By ~ 39

Author(s):

Shiva Sharma ◽

Ann E Ensley ◽

Katharine Hopkins ◽

George P Chatzimavroudis ◽

Timothy M Healy ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Flow Dynamics ◽

Total Cavopulmonary Connection ◽

Resonance Imaging ◽

Cavopulmonary Connection

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Assessment of cavopulmonary connections by advanced imaging: value of flat-detector computed tomography

Cardiology in the Young ◽

10.1017/s104795111200025x ◽

2012 ◽

Vol 23 (1) ◽

pp. 18-26 ◽

Cited By ~ 11

Author(s):

Martin Glöckler ◽

Andreas Koch ◽

Julia Halbfaß ◽

Verena Greim ◽

Andrè Rüffer ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Three Dimensional ◽

Supplementary Information ◽

Total Cavopulmonary Connection ◽

Clinical Value ◽

Flat Detector ◽

Flat Detector Computed Tomography ◽

The Impact ◽

Cavopulmonary Connection

AbstractObjectivesTo investigate the impact of flat-detector computed tomography on the clinical assessment of patients with cavopulmonary connections, and to evaluate the obtained diagnostic accuracy and supplementary information, as well as the value of overlaid three-dimensional reconstructions on fluoroscopic images during catheter-based interventions.MethodsWe analysed 31 consecutive patients retrospectively in whom flat-detector computed tomography was used to visualise the cavopulmonary connection. We investigated patients with cavopulmonary connections either early post-operatively (first group), before converting to a total cavopulmonary connection (second group), and patients with failing total cavopulmonary connection (third group). Flat-detector computed tomography based on a single rotational angiography was used to create a three-dimensional vascular model. The clinical value of flat-detector computed tomography was evaluated using standard categories of diagnostic utility. Used contrast volume and radiation exposure were quantified.ResultsWithin 18 months, flat-detector computed tomography was performed in 31 cases with cavopulmonary connections. The median age was 1.9 years (range 0.3–43 years). In the first group, we found anomalies in 4 out of 8 cases, which led to therapeutic or prophylactic procedures; in the second and third groups, we performed interventions in 14 out of 23 cases. The overall clinical value was always rated superior to conventional biplane angiography. The median dose area product was 91.8 microgray square metres (range 33.0–679.3 microgray square metres). The required contrast medium was 2.08 millilitres per kilogram (range 0.66–4.7 millilitres per kilogram).ConclusionFlat-detector computed tomography improves the diagnostic accuracy in cavopulmonary connections and provides additional diagnostic information, which may lead to therapeutic or prophylactic procedures. Overlaid three-dimensional images on fluoroscopy facilitate and provide security for interventions.

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New insight into left ventricular function in tricuspid atresia after total cavopulmonary connection: a three-dimensional echocardiographic study

Cardiology in the Young ◽

10.1017/s1047951100006521 ◽

2000 ◽

Vol 10 (2) ◽

pp. 83-89 ◽

Cited By ~ 3

Author(s):

Philippe Acar ◽

Zakhia Saliba ◽

Daniel Sidi ◽

Jean Kachaner

Keyword(s):

Left Ventricle ◽

Ejection Fraction ◽

Stroke Volume ◽

Three Dimensional ◽

Left Ventricular ◽

Tricuspid Atresia ◽

Total Cavopulmonary Connection ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography ◽

Cavopulmonary Connection

AbstractBackgroundIn patients with tricuspid atresia palliated by construction of a total cavopulmonary connection, both pulmonary and systemic circulations depend on the performance of the dominant left ventricle. When estimating the volume of such ventricles using cross-sectional echocardiography, it is necessary to make assumptions concerning the geometry of the ventricular shape. This is avoided by three-dimensional echocardiography, which provides direct volumetric data. Our purpose was to apply this new method to quantify left ventricular volumes and function in patients with tricuspid atresia after construction of a total cavopulmonary connection.MethodsWe studied ten patients (median age: 8 years) with tricuspid atresia who had undergone a total cavopulmonary connection, comparing them with 10 normal children matched for age, sex and size. The three-dimensional echocardiography was performed with electrocardio graphic and respiratory gating. A new transthoracic integrated probe designed for small children was used with a rotational scanning increment of 3°. The 60 slices obtained from the ventricular cavity were stored and formatted in a commercial system (TomTec®). End-diastolic and end-systolic volumes, stroke volume and ejection fraction were calculated after manual tracing of the endocardial surfaces. The volumes were indexed to the body surface area.ResultsAs seen in the reconstructions, the dominant left ventricle in tricuspid atresia had a spherical shape, whereas the normal left ventricle is oblong. The left ventricular volumes and function in tricuspid atresia were 54±4 ml/m2(end-diastolic volume), 28±3 ml/m2(end-systolic volume), 26±7 ml/m2(stroke volume) and 48±6% (ejection fraction). These volumes were not different from those obtained in the controls (p = NS). The left ventricular stroke volume and ejection fraction in 10 patients with tricuspid atresia were lower than those calculated for the controls (p < 0.05).ConclusionsThree-dimensional echocardiography provides a quantitative insight into the pathophysiologic function of the dominant left ventricle in tricuspid atresia after construction of a total cavopulmonary connection.

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