Intra-operative 3D Model Application as Surgical Navigation for Aortic Valve Leaflet Reconstruction for Bicuspid Aortic Valve Stenosis

We applied a 3D model customized by 3D-VR imaging, to the surgery of aortic valve leaflet reconstruction using three-same-sized leaflets of autologous pericardium (ATLAS) for a severe ASR patient of type 0 bicuspid aortic valve stenosis.

Axial images using enhanced ECG-triggered cardiac CT with slice thickness of 0.625mm were obtained. Subtracted volume rendering CT data were converted in a 3D workstation in order to assess the anatomical structure of the patient’s aortic root with VR image. Then, we designed reconstruction surgery with three same-sized leaflets; 1) Based on the right side commissure, the other two commissures were plotted with 120 degrees. 2) the left coronary sinus nadir was plicated with 3mm width so that three nadirs should be on the same plane. 3) The intra-leaflet triangle which would disturb leaflet-suture-line should be plicated. As for guiding of reconstruction, the 3D model of leaflet-suture-line was introduced to the aortic annulus durign the surgery. After each adjustment, three pieces of leaflets were sutured along the cusp-attachment lines indicated by this 3D model to complete ATLAS without AR and deflection of leaflets as simulated preoperatively.

Comment

Including a presenting case, we applied intraoperative 3D model for five patients. Preoperative evaluation by the 3D virtual reality image and intra-operative 3D navigation models provided valuable information for adjustment of the aortic root in our ATLAS surgery for unbalanced aortic root like type 0 bicuspid aortic valve disease.