3-D cardiac MR images enabled surgeons to plan optimal procedures virtually

A new imaging protocol using cardiac magnetic resonance imaging helped surgeons view predicted effects of different surgical procedures.

By using and manipulating 3-D images generated by cardiac magnetic resonance (CMR), a team of cardiac surgeons was able to map patient anatomy and predict how surgical approaches affected blood flow and other expected surgical outcomes prior to the procedure, according to study results. Researchers from several institutions collaborated and used the protocol to treat a 4-year-old patient with severe left pulmonary arteriovenous malformations due to abnormal hepatic flow distribution to the lungs.

According to the researchers who developed the technique, patients first undergo 3-D CMR for anatomy and flow reconstruction. Three sets of CMR images are then imported into a surgical planning interface where the surgeon can perform multiple virtual surgical scenarios. The surgeons also evaluate potential hemodynamics with a fluid dynamic solver, as well as efficiency metrics like pressure decrease and hepatic flow distribution. The combined results are then evaluated and used to select an optimal surgical option.

“This work introduces a whole new paradigm for addressing this problem by the use of an image-based surgical planning approach that can be used to optimize Fontan procedures on a patient-specific basis, which may prove beneficial and cost-effective to both the hospital and the patient in the long-term,” the researchers concluded. “Although the proposed framework was exemplified in the context of Fontan failure and pulmonary arteriovenous malformation correction, this approach can also be applied at earlier stages to optimize second and third stages and prevent the formation of pulmonary arteriovenous malformations.”

Sundareswaran KS. JACC: Cardiovascular Imaging. 2009;2:1024-1030.