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J Thorac Cardiovasc Surg 2009;138:571-580
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

The practical clinical value of three-dimensional models of complex congenitally malformed hearts

^a Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
^b German Cancer Research Centre Heidelberg, Division of Medical and Biological Informatics, Heidelberg, Germany
^c Philips Medical Systems, Hamburg, Germany
^d Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
^e University College London, Cardiac Unit, Institute of Child Health, London, United Kingdom

Received for publication November 7, 2008; revisions received January 14, 2009; accepted for publication March 9, 2009.

^_* Address for reprints: Eugénie Riesenkampff, MD, Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, D-13353 Berlin, Germany. (Email: riesenkampff{at}dhzb.de).

Objective: Detailed 3-dimensional anatomic information is essential when planning strategies of surgical treatment for patients with complex congenitally malformed hearts. Current imaging techniques, however, do not always provide all the necessary anatomic information in a user-friendly fashion. We sought to assess the practical clinical value of realistic 3-dimensional models of complex congenitally malformed hearts.

Methods: In 11 patients, aged from 0.8 to 27 years, all with complex congenitally malformed hearts, an unequivocal decision regarding the optimum surgical strategy had not been reached when using standard diagnostic tools. Therefore, we constructed 3-dimensional virtual computer and printed cast models of the heart on the basis of high-resolution whole-heart or cine magnetic resonance imaging or computed tomography. Anatomic descriptions were compared with intraoperative findings when surgery was performed.

Results: Independently of age-related factors, images acquired in all patients using magnetic resonance imaging and computed tomography proved to be of sufficient quality for producing the models without major differences in the postprocessing and revealing the anatomy in an unequivocal 3-dimensional context. Examination of the models provided invaluable additional information that supported the surgical decision-making. The anatomy as shown in the models was confirmed during surgery. Biventricular corrective surgery was achieved in 5 patients, palliative surgery was achieved in 3 patients, and lack of suitable surgical options was confirmed in the remaining 3 patients.

Conclusion: Realistic 3-dimensional modeling of the heart provides a new means for the assessment of complex intracardiac anatomy. We expect this method to change current diagnostic approaches and facilitate preoperative planning.