Correction of Pulmonary Arteriovenous Malformation Using Image-Based Surgical Planning
Kartik S. Sundareswaran, MS*,
Diane de Zélicourt, MS*,
Shiva Sharma, MD ,
Kirk R. Kanter, MD ,
Thomas L. Spray, MD ,
Jarek Rossignac, PhD¶,
Fotis Sotiropoulos, PhD#,
Mark A. Fogel, MD||,
Ajit P. Yoganathan, PhD*,*
* Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
Pediatric Cardiology Services, Atlanta, Georgia
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
|| Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
¶ College of Computing, Georgia Institute of Technology, Atlanta, Georgia
# Department of Civil Engineering, University of Minnesota, Minneapolis, Minnesota
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Figure 1 CMR Protocol
Cardiac magnetic resonance (CMR) protocol for reconstructing 3-dimensional (3D) anatomic and flows. 4D = 4-dimensional; CFD = computational fluid dynamics; FISP = fast imaging with steady-state precession; IVC = inferior vena cava; LPA = left pulmonary artery; PC CMR = phase-contrast cardiac magnetic resonance; RPA = right pulmonary artery; SVC = superior vena cava.
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Figure 2 3-Dimensional Anatomic Reconstruction Process
The 3-dimensional anatomic reconstruction process is as follows: 1) The TCPC is segmented in each slice; 2) the segmented contours are imported into Geomagic Studio 9.0 (Geomagic Inc., Research Triangle Park, North Carolina) in a point cloud format; and 3) a smooth surface is fitted to the points. AV = azygous vein; HV = hepatic vein; IV = inominate vein; TCPC = total cavopulmonary connection; other abbreviations as in Figure 1.
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Figure 3 Pre-Operative Hemodynamics Evaluated With the Use of CMR and CFD
Comparison of the pre-operative hemodynamics obtained in vivo by the use of PC CMR and simulated using CFD (Online Videos 1 and 2). Abbreviations as in Figures 1 and 2.
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Figure 4 Steps for the Virtual Surgery and Subsequent CFD Studies
Shown are the steps involved in virtual surgery and 3-dimensional geometric reconstruction of different surgical scenarios. (A) Pre-operative anatomy; (B) virtual surgery environment; and (C) resulting visual surgery options. Abbreviations as in Figures 1 and 2.
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Figure 5 Hemodynamic Efficiency Across all Surgical Options
Comparison of global performance measures across all considered anatomies. All numbers are obtained from the CFD simulations. For all cases, 70% of the total cardiac output exited through the LPA (Online Video 3). Abbreviations as in Figures 1 and 2.
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