PMC9433226_01
(a, b) Contrast-enhanced three-dimensional computed tomography images obtained at 8 days of age. (c, d) Patient-specific three-dimensional solid cardiovascular model based on computed tomography data at 8 days of age. Computed tomography scans were not electrocardiography-gated. (a) The frontal view. The left aortic arch was interrupted after the branching of the left common carotid artery (red arrow). (b) The rear view. This image shows the left distal arch connected to the ductus arteriosus (yellow arrow) and right distal arch (small yellow arrowheads). The right dorsal aorta was long and tortuous, with hemodynamic aortic coarctation. (c) The frontal view and (d) the rear view. Arteries are colored in red. Pulmonary arteries and veins are colored in blue. The patent ductus arteriosus is colored purple. The heart and vessel model was helpful to plan and simulate surgery.
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fig1
We developed a patient-specific 3D solid model (Figures 1(c) and 1(d)) from multidetector CT data to plan and simulate the surgical intervention.
PMC9433226_02
(a, b) Contrast-enhanced three-dimensional computed tomography images obtained at 8 days of age. (c, d) Patient-specific three-dimensional solid cardiovascular model based on computed tomography data at 8 days of age. Computed tomography scans were not electrocardiography-gated. (a) The frontal view. The left aortic arch was interrupted after the branching of the left common carotid artery (red arrow). (b) The rear view. This image shows the left distal arch connected to the ductus arteriosus (yellow arrow) and right distal arch (small yellow arrowheads). The right dorsal aorta was long and tortuous, with hemodynamic aortic coarctation. (c) The frontal view and (d) the rear view. Arteries are colored in red. Pulmonary arteries and veins are colored in blue. The patent ductus arteriosus is colored purple. The heart and vessel model was helpful to plan and simulate surgery.
CRIPE2022-5947951.001.jpg
PMC9433226_02_CRIPE2022-5947951.001.jpg
fig1
We developed a patient-specific 3D solid model (Figures 1(c) and 1(d)) from multidetector CT data to plan and simulate the surgical intervention.
PMC9433226_03
(a, b) Contrast-enhanced three-dimensional computed tomography images at 53 days of age. (c-e) Schema of the aortic reconstruction. (a) The frontal view. This image shows the narrowing of the patent ductus arteriosus (red arrow). (b) The rear view. Red small arrowheads indicate the right distal arch. The progression of narrowing and tortuousness of the right-sided aorta was shown compared to contrast-enhanced three-dimensional computed tomography images at 8 days of age. (c) The left aortic arch was interrupted, and the left subclavian artery arose from the left distal arch (interrupted aortic arch type B. Because there was a large gap, approximately 2 cm, between the ascending aorta and left distal arch, the left subclavian artery was resected from the distal arch to perform a direct anastomosis. The patent ductus ateriosus and adjacent ductal tissue were resected from the descending aorta. (d) The ascending aorta was cut back up to the undersurface of the proximal side of the left common carotid artery. The left distal arch was directly anastomosed to the undersurface of the arch (extended aortic arch anastomosis). (e) Anterior patch augmentation for the aortic arch was performed using glutaraldehyde-treated autologous pericardium. Superior vena cava (SCV), innominate vein (INN), ascending aorta (AAo), brachiocephalic artery (BCA), left common carotid artery (Lt-CCA), left subclavian artery (Lt-SCA), left distal arch (Lt-DA), main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA).
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fig2
Contrast-enhanced CT at 53 days of age (Figures 2(a) and 2(b)) revealed a progressive narrowing and tortuousness of the right aortic arch in addition to the PDA narrowing. The aortic arch was reconstructed by end-to-side anastomosis distal to the left subclavian artery (Figures 2(c)-2(e)).
(a, b) Contrast-enhanced three-dimensional CT images obtained 21 days after surgery. (a) The front view and (b) the rear view. There is no stenosis in the reconstructed left aortic arch (yellow arrow) and the right distal arch is regressed (small yellow arrowheads).
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fig3
At 3 weeks after surgery, contrast-enhanced CT showed no stenotic lesion of the repaired aortic arch or further regression of the right aortic arch (Figures 3(a) and 3(b)).