ArticleEuropean heart journal. Imaging methods and practice2025
Unveiling ccTGA complexity: CMR and 3D modelling for surgical planning-a case series.
Article in European heart journal. Imaging methods and practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart defect characterized by atrioventricular and ventriculoarterial discordance and frequently associated with heterogeneous anatomical anomalies. This variability makes surgical indication and strategy particularly complex, requiring accurate preoperative anatomical and functional assessment. We report four paediatric patients with complex ccTGA who underwent anatomical repair at our institution between July 2022 and March 2024. Associated findings included dextrocardia, situs inversus, ventricular septal defects, pulmonary outflow tract obstruction, and atrioventricular valve abnormalities. Methods and results: All patients underwent stepwise multimodal imaging. Transthoracic echocardiography was complemented by cardiovascular magnetic resonance (CMR) to assess ventricular volumes and function, septal defects, outflow tract relationships, and systemic and pulmonary venous return. CMR datasets were processed to generate patient-specific virtual and 3D-printed models through dedicated segmentation, preserving real anatomical dimensions. These models were used for surgical simulation and multidisciplinary planning. Integration of CMR and 3D modelling directly influenced operative strategy in all cases. 3D reconstructions refined ventricular septal defect tunnelling towards the aorta, optimized ventriculotomy site selection, clarified atrial switch configuration, and anticipated the need for pulmonary root translocation. Anatomical repair was successfully achieved in all four patients, with no early mortality and preserved biventricular function at short follow-up. Conclusion: Structured integration of CMR and patient-specific 3D modelling enhances spatial understanding and supports individualized surgical planning in complex ccTGA. Incorporating advanced imaging into routine clinical workflow represents a valuable strategy to improve precision and decision-making in anatomically challenging congenital heart disease.
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