Author + information
- Received June 25, 2018
- Revision received October 1, 2018
- Accepted October 1, 2018
- Published online May 6, 2019.
- Animesh Tandon, MD, MSa,b,∗ (, )@ATandonMD,
- Barbara E.U. Burkhardt, MDa,
- Maria Batsis, MDa,
- Thomas M. Zellers, MDa,
- Mari Nieves Velasco Forte, MDc,
- Israel Valverde, MDd,
- Ryan P. McMahan, PhDe,
- Kristine J. Guleserian, MDf,
- Gerald F. Greil, MD, PhDa,b and
- Tarique Hussain, MD, PhDa,b
- aDepartment of Pediatrics (Cardiology), University of Texas Southwestern Medical Center, Children’s Medical Center Dallas, Dallas, Texas
- bDepartment of Radiology, University of Texas Southwestern Medical Center, Children’s Medical Center Dallas, Dallas, Texas
- cDivision of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- dPediatric Cardiology, Hospital Universitario Virgin del Rocio and Institute of Biomedicine of Seville, Seville, Spain
- eDepartment of Computer Science, University of Texas at Dallas, Dallas, Texas
- fDivision of Pediatric Cardiovascular Surgery, Nicklaus Children’s Hospital, Miami, Florida
- ↵∗Address for correspondence:
Dr. Animesh Tandon, University of Texas Southwestern Medical Center, Children’s Medical Center Dallas, Department of Pediatric Cardiology, 1935 Medical District Drive, Dallas, Texas 75235.
Recently, transcatheter closure of sinus venosus defects (SVDs) with covered stents has been reported. Because of wide anatomic variability of SVDs, it is unclear which patients are candidates for transcatheter closure. We used cardiac magnetic resonance and computed tomographic imaging to characterize the anatomic variability of our patients with SVDs (Figures 1, 2, 3, 4, 5, and 6, Videos 1, 2, 3, and 4). We then created interactive, virtual reality models of patient-specific anatomy and assessed whether a covered stent placed in the superior vena cava (SVC) would have successfully redirected anomalous pulmonary venous flow to the left atrium. The stent diameter was sized slightly larger than the SVC (∼2 to 6 mm) to allow the stent to sit tightly without SVC injury (1). Of 28 patients, 6 were deemed unsuitable for covered stent placement because a large anomalous pulmonary vein would have been blocked, 4 were unsuitable for other anatomic reasons, and 7 were deemed equivocal as only a small anomalous pulmonary vein would have been blocked (Supplemental Appendix).
SVDs encompass a large range of anatomic variants, and transcatheter closure is an option for some patients. The virtual reality environment provided 3-dimensional information about anatomic relationships that were not immediately obvious on 2-dimensional imaging and thus provides an excellent platform for planning patient-specific interventions in congenital heart disease.⇑⇑⇑⇑⇑⇑
This work was supported by the Pogue Family Distinguished Chair in Pediatric Cardiology (to Dr. Greil). Drs. Tandon and Hussain have significant ownership interest in VARYFII Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 25, 2018.
- Revision received October 1, 2018.
- Accepted October 1, 2018.
- 2019 American College of Cardiology Foundation