Study of anatomic constraints using three dimensionally reconstructed images for total artificial heart implantation

The authors established a method of clarifying the three dimensional interrelationship among the mitral and tricuspid annuli, ascending aorta, main pulmonary artery, diaphragmatic surface of the heart (DS), and anterior thoracic wall, using four chamber view magnetic resonance imaging. This method was applied to measuring the parameters that restrict the size and shape of a total artificial heart (TAH) from three dimensional reconstructed images of six normal subjects. Assuming that the TAH is implanted on the diaphragm, which corresponds to DS, the width of the TAH is restricted to 7.6 cm, the transverse dimension of the cardiac base (D-B), and the height to 7.8 cm, the dimension from the DS to the center of the pulmonic annulus (DS-P1). Depth is restricted by the longitudinal dimension of the left ventricle projected on the DS (D-L). While D-L in early systole is 9.7 mm, in late systole D-L is reduced to 7.6 cm. The angle (DS) (AW) is 65.7 degrees; this is the angle between the DS and anterior thoracic wall that restricts the shape of the TAH. While these data in normal subjects may be useful for TAH implantation, in the patient with acute cardiac failure, further study of patients with chronic cardiac failure is necessary.