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[Surgical Replacement of Descending Aorta for Adult Aortic Coarctation by Using Three-dimensional Computer Graphics
Hiroaki Aizawa1, Takayuki Gyoten, Hidetomi Takahashi
1Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan.
Insights
Preoperative 3D imaging precisely identified abnormal vessels in a patient with aortic coarctation, enabling safe surgical repair. This approach avoided blood transfusion and normalized ankle-brachial index (ABI) post-surgery.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Innovation
Background:
- Aortic coarctation affects about 5% of adults with congenital heart disease, often presenting as hypertension.
- Surgical repair of adult aortic coarctation carries risks, particularly injury to collateral vessels, potentially necessitating blood transfusion.
- Advanced imaging is crucial for planning complex cardiovascular surgeries.
Purpose of the Study:
- To evaluate the utility of preoperative three-dimensional computer graphics (3DCG) reconstruction using a medical image viewer for identifying abnormal collateral vessels in adult aortic coarctation.
- To assess the safety and efficacy of surgical aortic replacement guided by 3DCG in preventing intraoperative injury and transfusion requirements.
Main Methods:
- A 34-year-old male patient with diagnosed aortic coarctation, hypertension, and low ABI underwent preoperative chest CT scan.
- Three-dimensional computer graphics (3DCG) reconstruction was utilized to visualize and precisely identify abnormal collateral vessels.
- Descending aorta replacement was performed via thoracotomy under partial extracorporeal circulation, with surgical strategy informed by 3DCG findings.
Main Results:
- 3DCG reconstruction accurately depicted the anatomical abnormalities of collateral vessels.
- Surgical intervention successfully treated the aortic coarctation without any injury to the identified collateral vessels.
- The patient was discharged 10 days postoperatively, with no blood transfusion required and a normalized ABI.
Conclusions:
- Preoperative 3DCG reconstruction is a valuable tool for enhancing surgical safety in adult aortic coarctation by precisely identifying abnormal collateral vessels.
- This imaging technique facilitates meticulous surgical planning, leading to successful aortic repair without complications like blood transfusion.
- The successful management of this case highlights the potential of advanced medical imaging in improving outcomes for complex congenital heart disease surgeries.
Abstract:
Aortic coarctation is diagnosed in approximately 5% of adult patients with congenital heart disease and is commonly diagnosed through the close examination of hypertension. Various surgical strategies for adult coarctation have been recently reported. Generally, aortic replacement may require blood transfusion in case of injury of the well-developed collateral vessels. Therefore, in order to secure an operative safety, we preoperatively used a medical image viewer to identify the abnormal vessels by three-dimensional computer graphics (3DCG) reconstruction. A 34-year-old male patient was referred to our hospital with hypertension and low ankle-brachial pressure index( ABI). Chest computed tomography( CT) scan showed aortic coarctation and development of abnormal collateral vessels. Descending aorta was replaced via a left third-fourth intercostal thoracotomy under partial extracorporeal circulation. As the image viewer depicted, anatomical abnormality of the collateral vessels was identified precisely, and surgically treated without any injury. The patient was discharged 10 days postoperatively without transfusion and with a normalized ABI.
