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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 464-473, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Preoperative three-dimensional reconstruction of the heart and great vessels in patients with congenital heart disease. Technique and initial results

JC Laschinger, MW Vannier, F Gutierrez, S Gronemeyer, CS Weldon, TL Spray and JL Cox
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, MO 63110.

Magnetic resonance images have been obtained preoperatively in six patients with congenital heart disease. Contiguous sequences of electrocardiogram-triggered spin-echo images have been reconstructed in three-dimensional form to define the size and anatomic relationships to the great vessels and internal cardiac structures. Findings of magnetic resonance imaging were corroborated by angiographic and sector-scan echocardiographic studies and at operation. Individual scan slices were manually edited to separate the heart and great vessels from the blood within them and from extracardiac structures. Surface reconstruction software originally developed for craniofacial and orthopedic surgical planning was adapted for processing of cardiac magnetic resonance image sequences. Preoperative three-dimensional magnetic resonance imaging reconstructions were obtained in patients with aortic coarctation with ventricular septal defect, hypoplastic left ventricle, pulmonary artery atresia with ventricular septal defect, atrial septal defect, partial atrioventricular canal defect with anomalous pulmonary venous drainage, and tetralogy of Fallot with peripheral pulmonary artery stenosis. The reconstructions showed anatomic findings consistent with two- dimensional magnetic resonance imaging, echocardiography, cineangiography, and intraoperative findings. The three-dimensional images have a format that is familiar and consistent with the gross intraoperative appearance of the heart and great vessels. These three- dimensional images can facilitate the interpretation of magnetic resonance scan findings for cardiac surgeons without the sacrifice of significant clinical information.