Purpose-Built Transcatheter Cavopulmonary Anastomosis Device Requirements: Multi-Modality Imaging Evaluation

Area of Science:

• Pediatric cardiology
• Medical imaging
• Surgical innovation

Background:

• Patients with functional single ventricle often require multiple palliative open-heart surgeries, including superior cavopulmonary anastomosis (or bidirectional Glenn shunt).
• A less-invasive transcatheter approach could potentially decrease patient morbidity associated with traditional surgical methods.

Purpose of the Study:

• To evaluate imaging modalities for pre-operative assessment of patients undergoing Glenn shunt procedures.
• To determine optimal device dimensions for a transcatheter superior cavopulmonary anastomosis.

Main Methods:

• Analysis of pre-Glenn X-ray contrast angiography (XA), cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) studies from 139 patients.
• Measurement of superior vena cava (SVC) and right pulmonary artery (RPA) dimensions, SVC-RPA angle, and potential device lengths across imaging modalities.
• Assessment of image quality for each modality.

Main Results:

• Mean SVC and RPA measurements were comparable across XA, CT, and CMR.
• Ideal device length varied by imaging modality, with CMR suggesting longer devices.
• Image quality was sufficient for most CT and XA studies, and for most SVC and RPA measurements in MRI.

Conclusions:

• Parametric modeling suggests a 10 mm diameter and 20-25 mm length device is ideal for transcatheter superior cavopulmonary anastomosis.
• Imaging modalities like CT and CMR provide valuable pre-operative data for planning less-invasive procedures.