A novel three-dimensional endocardial surface image in congenital heart defects

  • Hisayuki Oda, Pediatric cardiology division, Fukuoka Children’s Hospital, Japan
  • Dr Hiroya Ushinohama, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Shirou Ishikawa, Pediatric cardiology division, Fukuoka Children’s Hospital, Japan
  • Dr Yuichi Ishikawa, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Makoto Nakamura, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Kouichi Sagawa, Pediatric cardiology division, Fukuoka Children’s Hospital, Japan
  • Toshihide Nakano, Cardiac surgery division, Fukuoka Children’s Hospital, Japan
  • Hideaki Kado, Cardiac surgery division, Fukuoka Children’s Hospital

    • Background: Three-dimensional (3D) images with CT/MRI only show us the extra-cardiac structure. We addressed to slice novel 3D endocardial surface images in congenital heart defects and to compare them with surgical findings.
    Methods and Results: First, patients with heart defects were imaged with a 16-slice multidetector CT scanner. Helical CT scanning was performed from the head to the diaphragm after intravenous injection of contrast media. Using the image data (DICOM 3) burned onto a CD directly at the scanner, postprocessing of the axial CT images was performed with an electro-anatomic mapping system (CartoTMXP, Biosense Webster Inc). Image segmentation, the extraction of the 3D anatomy of individual structures from the cardiac CT images, was performed with an image segmentation and integration module (CartoMergeTM, Biosense Webster Inc). The chambers and vessels of interest were identified with semi-automatic process. Cutting and punching tools were available for fine tuning. With the clipping plane function, we could slice images in any plane to visualize the endocardial surface. In 1 year-old girl with DORV after PA banding, the 3D endocardial surface images from the RV clearly showed a position and shape of non-committed VSD. And in 9 month-old boy with DORV and PS, the 3D endocardial surface images from the LV suggested small apical muscular VSD. The findings of two patients were entirely consistent with the surgical findings.
    Conclusion: The three-dimensional endocardial surface images using the CartoTMXP system and CartoMergeTM Image Integration Module have a potential of diagnostic tool for congenital heart defects.