Characterizing Single Ventricle Patient-Specific Anatomy Using Segmentation of MRI and 3D Reconstruction to Aid Surgical Planning

Abstract

Single ventricle congenital heart defects occur 2 per every 1000 live births in the USA. In these cases, cyanosis occurs due to the mixing of venous deoxygenated blood and oxygenated blood from the lungs. These defects are surgically treated by the total cavo-pulmonary connection (TCPC), where the superior and inferior vena cavae are connected to the pulmonary arteries routing the systemic venous return directly to the lungs. However, this Fontan repair results in high energy losses and therefore the optimization of this connection prior to the surgery could significantly improve post-operative performance. In this paper, the in-house segmentation and 3D reconstruction scheme is used in the following studies. First, 3D geometrical analysis of the TCPCs is used to determine the advantages and disadvantages of two commonly performed TCPC palliations intra-atrial and extra-cardiac configurations. Then, a surgical planning outline is proposed with segmentation of pre and post surgical Magnetic Resonance Imaging (MRI) data followed by the 3D reconstruction with emphasis on extracting surrounding vessels and structures. A pediatric surgeon performs a virtual surgery on the reconstruction of the patient s pre-Fontan anatomy prior to the actual surgery. A segmentation of the heart, aorta and surrounding vessels superimposed with the Glenn, when used with the SURGEM® tool, simulates the actual Fontan operation. This outline allows the surgeon to envision numerous scenarios of possible surgical options, and accordingly to predict the post operative procedures. The segmentation tool is improved upon to increase the accuracy and efficiency of the process and enhance the quality of the anatomical reconstructions.