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Three-Dimensional Printing of a Complex Aortic Anomaly
Published on: November 1, 2018
Three-dimensional rotational digital angiography in a complicated case of patent ductus arteriosus transcatheter
Gianluca Rigatelli1, Alberto Zamboni, Paolo Cardaioli
1Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
Insights
Three-dimensional rotational angiography proved crucial for successfully closing a complex patent ductus arteriosus. This advanced imaging technique aids in selecting the optimal device for congenital heart disease interventions.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Patent ductus arteriosus (PDA) closure is a common intervention in congenital heart disease.
- Accurate anatomical assessment is vital for successful device closure, especially in complex or previously treated cases.
Observation:
- A 64-year-old woman presented with a recurrent PDA after prior surgical ligation.
- Echocardiography confirmed PDA patency, but cardiac MRI faced challenges in precise ductal measurement due to its orientation and morphology.
- 3D rotational angiography provided critical imaging for accurate ductal assessment.
Findings:
- 3D rotational angiography identified the optimal projection for measuring the ductus arteriosus.
- This facilitated the selection and successful implantation of a 5/4-mm Amplatzer Duct Occluder.
- The procedure resulted in excellent outcomes for the patient.
Implications:
- 3D rotational angiography demonstrates significant utility as an imaging tool in interventional cardiology for congenital heart disease.
- It may enhance the success rates of procedures like PDA closure and aortic coarctation repair.
- This technique offers a valuable approach for complex anatomical challenges in structural heart interventions.
Abstract:
There has been no report so far as to the usefulness of 3D rotational angiography in congenital heart disease interventions. We present a case of a difficult patent ductus arteriosus in which 3D rotational angiography was the key to successful closure. A 64-year-old woman who had been operated on many years previously for a patent ductus arteriosus came to our attention for a heart murmur on the left upper sternal border. Echocardiography revealed a still patent duct with moderate shunt. The patient underwent cardiac magnetic resonance imaging, which confirmed patency of the duct, but its diameter and length were difficult to measure due to the particular orientation and morphology of the previously legated duct. It was decided to attempt device closure. Three-dimensional rotational digital subtraction technique enabled us to find the most useful projection for measuring the duct and selecting the best implant device (coil or Amplatzer device). The exact oblique and cranio-caudal degree of the selected projection on rotational 3D reconstruction was replicated to obtain the best standard digital subtraction angiographic view of the duct. Thus, a 5/4-mm Amplatzer Duct Occluder was selected and successfully implanted with excellent results. This case suggests that 3D rotational angiography may be an important imaging tool to guide congenital heart disease interventions such as patent ductus arteriosus closure or aortic coarctation repair.
