PMC10229129_01
Transthoracic echocardiography pre-Bentall surgery. Panel (A) parasternal long-axis view PLAX, panel (B) short-axis view showing the ascending aorta aneurysm of 7 cm. Panel (C) Doppler single showing severe aortic regurgitation. Panel (D) Apical long axis view showing ascending aorta aneurysm compressing the left atrium. Panel (E) and (F) showing severe aortic regurgitation with vena contracta of 8 mm in apical three-chamber and five-chamber, respectively.
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The indication of surgery was bicuspid AV, severe aortic regurgitation, ascending aortic aneurysm of 7 cm in diameter, coarctation of the descending aorta, and severe left ventricular (LV) systolic dysfunction and dilatation (Fig. 1).
Echocardiography. Panel (A) Long axis view of TEE showed the posterior pseudoaneurysm (yellow arrow) with color doppler in the adjacent image showed communication between the pseudoaneurysm and LVOT. Panel (B) Short axis view of TEE showing the posterior pseudoaneurysm (yellow arrow) and mechanical aortic valve with adjacent image color doppler showed no paravalvular leak. Panel (C) color doppler imaging along with M-mode showing systolic expansion of pseudoaneurysm. Panel (D) CW-doppler showing systolic-flow from LVOT to posterior pseudoaneurysm. TEE: Transesophageal echocardiography, LVOT: left ventricular outflow tract, LA: left atrium, AV: aortic valve prothesis, RV: right ventricle.
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TEE revealed a circumferential pseudoaneurysm communicating with LVOT (Fig. 2).
Cardiac computed tomography. Panel (A), (B), (C): axial, sagittal, coronal multiplanar views, respectively, from reconstructed CT images showing the anterior (arrow head) and posterior (arrow) pseudoaneurysms. Panel (D): 3D reconstructed CT images showing the anterior (arrow head) and posterior (arrow) pseudoaneurysms. Ao: aortic graft, LVOT: left ventricle outflow tract, LA: left atrium.
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A cardiac CT scan revealed the presence of stable pseudoaneurysms arising from the anterior and posterior subvalvular LVOT, as well as a well-seated prosthetic AV (Fig. 3).
Three-dimensional (3D) replica. 3D replica (printing) showing pseudoaneurysms (arrows) communication with LVOT (thin red arrow). LV: left ventricular, LA: left atrium, PV: pulmonary vein, AVTG aortic valve graft tube.
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Using 3D printing from reconstructed CT images, the anatomy was better understood and pre-operative planning was greatly facilitated (Figs. 4 and 5).
The process of separation and preparation before 3D printing. Showing 3D process involving the separation of the area of interest before printing from complete model on the left side of the figure, to the area of interest in the right side. Arrows indicated the pseudoaneurysms. LV: left ventricle, AVTG aortic valve graft tube.
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Using 3D printing from reconstructed CT images, the anatomy was better understood and pre-operative planning was greatly facilitated (Figs. 4 and 5).