Visualization and Quantification of the Unrepaired Complete Atrioventricular Canal Valve Using Open-Source Software.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Congenital Heart Disease

Background:

• Complete atrioventricular canal (CAVC) repair can result in residual atrioventricular valve regurgitation.
• Previous studies linked mitral and tricuspid valve structure to dysfunction in biventricular hearts.
• The three-dimensional (3D) structure of unrepaired CAVC valves remains unquantified.

Purpose of the Study:

• To create and apply novel open-source workflows for 3D modeling and quantification of CAVC valves.
• To understand the 3D structure of the native CAVC valve.
• To inform optimized surgical repair strategies for CAVC.

Main Methods:

• Developed open-source workflows in SlicerHeart for 3D modeling and quantification of CAVC valves.
• Utilized transthoracic 3D echocardiography to model the annulus, leaflets, and papillary muscles (PM) in 35 CAVC patients.
• Compared CAVC valve structure metrics with normal mitral valves and analyzed associations with atrioventricular valve regurgitation.

Main Results:

• Significant variations in CAVC leaflet metrics were observed throughout systole.
• Compared to normal mitral valves, CAVC left papillary muscles showed altered angles and rotations.
• Lower annular height and annular height-to-valve width ratio in CAVC were associated with moderate or greater regurgitation post-repair.

Conclusions:

• Feasible to model and quantify 3D CAVC structure using 3D echocardiographic images.
• Demonstrated significant structural variations in CAVC annulus, leaflets, and PMs compared to mitral valves.
• These 3D modeling tools can advance research into structural associations of valve dysfunction and optimize CAVC repair.